JP2019508096A - System and method for tissue removal - Google Patents

Abstract

  Systems and methods are provided for preventing molarisation of a tissue sample inside the patient's body, and the dissemination of cancerous cells in removing the tissue sample from inside the patient through the minimally invasive body opening to the outside of the patient. One system includes a cut resistant tissue guard that is removably insertable into the storage bag. The tissue sample is isolated and contained in a storage bag, and the guard protects the storage bag and surrounding tissue from accidental contact with the molars and sharp instruments during extraction of the tissue sample. The guard is adjustable for easy insertion and removal and is configured to be securely fixed in the body opening. A protection-focused, containment-based system for tissue removal is provided that allows for minimally invasive procedures to be performed safely and efficiently.

Description

  The present invention relates to medical devices, and more particularly to systems and methods for the removal of tissue through a body opening.

  Priority is claimed on US Provisional Patent Application No. 62 / 281,820, entitled "Systems and methods for tissue removal," filed January 22, 2016, which is incorporated herein by reference in its entirety. Insist on its benefits.

  Systems and methods for surgical tissue removal through a small incision site and / or a body opening including a body orifice are described. Where necessary, a small incision is made in the patient to access surgical target tissue located inside the body cavity. In some cases, surgical target tissue may be approached through the body orifice without an initial incision. Sometimes, one approaches the target tissue directly through the incision or body orifice. In other cases, the access device system may be positioned and / or positioned to retract tissue into, into, and / or through the incision and / or body orifice. Retract, enlarge, deform, and / or isolate the incision or body orifice. The access device system serves as an entrance for accessing target tissue located or adjacent to a body cavity or body orifice. The target tissue is peeled away from adjacent and surrounding tissue using known surgical procedures and procedures. Once freed, the target tissue is ready to be removed through a small incision or body orifice. If the target tissue is too large to be removed in its entirety, its size is reduced and removed piece by piece through a small incision. Ideally, the surgeon "cores" or "peels" the target tissue to keep it as one piece as possible. However, if anything, the target tissue is often subdivided into pieces.

  Reducing the size of the target tissue is called molselation. The morseration procedure involves cutting the target tissue into smaller pieces, for example with a scalpel or knife, or cutting using a power molserator, so that the target tissue can be removed through a small incision. A piece of target tissue is removed from the patient through a small incision. When reducing the size of the target tissue so that it can pass through the small incision, small pieces of tissue may be detached and left inside the patient. Therefore, molaration is contraindicated in cases of malignancy or endometriosis. When the cancer is morcellated, it can spread the malignant tissue, raise the stage of the cancer, and increase patient mortality.

  Hysterectomy is an example of a surgical procedure that may be accompanied by molseration. More than 500,000 hysterectomies are performed annually for women in the United States. A common reason that women may undergo hysterectomy is the presence of uterine fibroids, cancer, endometriosis or uterine prolapse. Of these hysterectomies, approximately 200,000 are performed laparoscopically. If the uterus is too large (> 300 g) to be removed through the vagina, or if the neck is still in place, the size of the specimen must be reduced so that it can be removed through the abdominal incision or vagina. During uterine fibroids (eomyoma removal), large fibroids may also need to be removed using a morsulation procedure. During molseration, the target tissue (usually the uterus, sometimes an appendage structure) is moved to the abdominal wall surface, such as by tissue grasper, and its size is reduced using a blade and removed from the pelvic cavity through the incision Do. In another variation, the target tissue is removed through the body orifice, eg, through the vagina. Uterine fibroids or uterine leiomyomas account for about 30-40% of hysterectomy. These are benign tumors of the uterus and can result in massive and painful bleeding. Previously, the possibility that these tumors were undetected cancer or leiomyosarcoma was less of a concern, and was thought to affect approximately 1 in 10,000 women. More recent data have shown that the risk of undetected malignancy in these tumors proves to be higher, and the range was estimated to be 1: 1000 to 1: 400. Because of this increased risk, many surgeons are beginning to alter their procedure to contain the analyte, and instead of using the procedure called open molselation to perform the molseration without using the bag, There is a closed molseration process that accommodates the pieces that are deviated by serration to prevent the spread and dissemination of tumor cells. Many GYN (Gynecology) societies, including AAGL, ACOG, and SGO, have issued a statement warning of the potential hazards of open molseration. As of April 17, 2014, the FDA issued a statement stating that it does not encourage the use of open powered molars for women undergoing hysterectomy and uterine myomectomy for fibroids. The FDA has also raised estimates of the likelihood of malignancy to 1 in 350. For these reasons, there is a need for systems and methods for safely and effectively reducing tissue specimens. The present invention describes such a secure system and method for both manual and powered molaration performed within a closed system.

US Patent Application Publication No. 2011/0054260

  According to one aspect of the present invention, a surgical shield is provided for insertion into and protection of a patient's orifice. The surgical shield includes a guard portion formed in a generally tubular shape from a cut resistant material. The guard portion has an inner surface and an outer surface defining a thickness therebetween. A lumen extends along the longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end of the shield. The shield further includes a batten having a reinforced portion connected to the handle portion. The reinforcement portion is connected to the guard portion and extends along the longitudinal axis of the guard portion. The handle portion is located at the proximal end of the guard portion and extends away from the proximal end of the guard portion to facilitate insertion of the shield.

  According to another aspect of the present invention, a surgical shield is provided for insertion into and protection of a patient's orifice. The surgical shield includes a guard portion having an expanded state and a contracted state. The guard portion is made of a cut resistant flexible material biased to return to the expanded state when deformed. The guard portion is generally tubular in shape and defines a lumen extending along the longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end. The guard portion has a transverse axis perpendicular to the longitudinal axis. The distal opening is located in a distal plane at an angle to the longitudinal axis and forms a distal insertion wedge at the distal end to facilitate insertion of the shield into the patient's orifice.

  According to another aspect of the invention, a method is provided. The method includes the steps of providing a shield having a guard portion having an expanded state and a contracted state. The guard portion is made of a flexible material biased to return to the expanded state. The guard portion is generally tubular in shape and defines a lumen extending along the longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end. The method comprises the steps of: placing the guard portion in the contracted state; inserting the shield into the patient's orifice while in the contracted state; and releasing the shield from the contracted state, which expands towards the expanded state. And abut against the orifice.

  According to another aspect of the invention, a method is provided. The method includes the step of providing a shield having a guard portion made of a flexible, cut resistant material. The guard portion is generally tubular in shape and defines a lumen extending along the longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end. The shield includes a batten removably connected to the guard portion. The batten is relatively stiffer than the guard portion. The batten has a reinforced portion connected to the handle portion. The reinforcing portion is connected to the guard portion so as to extend along the longitudinal axis of the guard portion. The handle portion is located at the proximal end of the guard portion and extends away from the proximal end of the guard portion. The method includes the steps of connecting the batten to the guard portion and inserting the shield into the patient's orifice while the batten is connected to the guard portion.

FIG. 6 is a cross-sectional view of a storage bag and a guard disposed at an opening in a body wall according to the present invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a side view of a guard according to the invention. Fig. 2 is an end view of a guard according to the invention; FIG. 5 is a cross-sectional view along line 5-5 of FIG. 4 of a guard according to the invention; 6 is a cross-sectional view along line 6-6 of FIG. 4 of a guard according to the present invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a side view of a guard according to the invention. Fig. 2 is an end view of a guard according to the invention; FIG. 10 is a cross-sectional view along line 10-10 of FIG. 9 of a guard according to the present invention. Fig. 2 is a top perspective view of a cap according to the invention; FIG. 5 is a side cross-sectional view of a cap and a guard according to the invention. FIG. 5 is a side view of a cap and a guard according to the invention. Fig. 2 is a top perspective view of a cap and a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Fig. 2 is a side sectional view of a guard according to the invention. 1 is a top perspective view of a retractor according to the present invention. 1 is a top perspective view of a retractor according to the present invention. FIG. 5 is a top perspective view of the storage bag and retractor combination according to the present invention. FIG. 2 is a side cross-sectional view showing a tissue sample, a body wall, and a storage bag according to the present invention with two rings. FIG. 1 is a top perspective view of an expanded storage bag according to the present invention. FIG. 1 is a top perspective view of a partially collapsed storage bag according to the present invention. FIG. 5 is a top perspective view of the storage bag in a twisted state according to the invention; FIG. 5 is a plan view of the storage bag in a twisted state according to the present invention. FIG. 5 is a top perspective view of the disassembled two-part guard according to the invention. FIG. 1 is a top perspective view of an assembled two-piece guard according to the invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 5 is a top perspective view of a retractor ring and guard according to the present invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 5 is a partial cross-sectional view of a retractor ring and a guard according to the present invention. FIG. 1 is a top perspective view of a balloon trocar according to the present invention with a removable seal housing. FIG. 1 is a side cross-sectional view of a balloon trocar according to the present invention. FIG. 1 is a side view of a stabilizer according to the invention. Figure 2 is a bottom view of the stabilizer according to the invention. FIG. 34 is a cross sectional view along line 34-34 of FIG. 33 of a stabilizer according to the present invention. FIG. 2 is a side view of a morcellator stabilizer according to the invention. FIG. 5 is a cross-sectional plan view of the morcellator stabilizer in a locking configuration according to the invention; FIG. 7 is a plan view of the stabilizer in the unlocked configuration according to the invention; FIG. 5 is a cross-sectional plan view of the molcellator stabilizer in the unlocked configuration according to the present invention. FIG. 5 is a top perspective view of a storage bag disposed at a body opening according to the present invention. FIG. 5 is a top perspective view of a storage bag disposed at a body opening according to the present invention and a morcellator stabilizer in an unlocked configuration connected to the storage bag. FIG. 6 is a top perspective view of a morcellator having a protected obtator connected to a stability cap according to the invention. FIG. 5 is a bottom perspective view of a morcellator having a protected obturator connected to a stability cap according to the invention. FIG. 5 is a top perspective view of a morcellator connected to a stability cap according to the invention. 1 is a top perspective view of a stability cap according to the invention. FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 5 is a side cross-sectional view of a tissue sample inside a storage bag disposed across a body wall according to the present invention. FIG. 1 is a side view of a storage bag deployment apparatus according to the present invention. FIG. 6 is a side view of a storage bag and deployment cap according to the present invention. FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 5 is a side cross-sectional view of a tissue sample inside a storage bag disposed across a body wall according to the present invention. FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 1 is a top perspective view of a storage bag according to the invention. 1 is a plan view of a storage bag according to the present invention. FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 1 is a plan view of a pattern of a storage bag according to the invention, the solid lines showing valley folds and the broken lines showing mountain folds FIG. 5 is a partial plan view of a dimensioned pattern of a storage bag according to the invention. FIG. 5 is a plan view of a pattern of storage bags that is substantially square when viewed from above according to the present invention. FIG. 5 is a plan view of a storage bag having a triangular open end according to the present invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 5 is a top perspective view of a guard inside a mold according to the invention. Figure 2 is a plan perspective view of a guard on a mold according to the invention; FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 5 is a side view of a ring of a storage bag according to the invention; FIG. 55B is a cross-sectional view of FIG. 55A at line 55B-55B of the storage bag ring according to the present invention. FIG. 5 is a top perspective view of the semi-rigid rod prior to being formed into the ring of the storage bag according to the present invention. FIG. 5 is a top perspective view of a ring of a storage bag according to the invention; FIG. 5 is a plan view of the side wall of the storage bag according to the invention. Fig. 2 is a side view of the side wall of the storage bag according to the invention; FIG. 1 is a side view of a storage bag according to the invention. FIG. 58B is a cross-sectional view along section 58B of FIG. 58A of a storage bag according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 1 is a top perspective view of a storage bag according to the invention. FIG. 1 is a top perspective view of a bag introducer according to the invention. FIG. 1 is a top perspective view of a bag introducer according to the invention. FIG. 1 is a top perspective view of a storage bag and bag introducer according to the invention. FIG. 1 is a top perspective view of a storage bag and bag introducer according to the invention. FIG. 1 is a top perspective view of a guard and bag introducer according to the present invention. FIG. 5 is a side cross-sectional view of a tissue sample inside a storage bag according to the present invention and a guard placed across the body wall. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 6 is a side view of two sidewall components of a guard according to the invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a side view of a guard according to the invention. Fig. 2 is a side view of a body opening according to the invention. Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a semi-transparent side view of a guard according to the invention. FIG. 1 is a semi-transparent side view of a guard according to the invention. FIG. 5 is a cross-sectional view of a side wall of a guard according to the invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a side view of a guard according to the invention. FIG. 5 is a semi-transparent bottom view of a guard according to the invention; FIG. 1 is a semi-transparent top view of a guard according to the invention; FIG. 78B is a cross-sectional view of FIG. 78B taken along line 78C-78C of a guard according to the present invention. FIG. 1 is a semi-transparent plan perspective view of a guard according to the invention; Figure 2 is a plan view of a guard according to the invention; Figure 2 is a plan view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan cross-sectional view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; FIG. 5 is a side view of a morcellator and a guard according to the invention. FIG. 2 is a side cross-sectional view of a morcellator and guard according to the present invention. FIG. 2 is a bottom perspective view of a morcellator according to the invention. FIG. 1 is a top perspective view of an energy molcerator and a grasper according to the present invention. Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a semi-transparent plan perspective view of a guard according to the invention; FIG. 1 is a side view of a guard according to the invention. FIG. 1 is a semi-transparent side view of a guard according to the invention. Figure 2 is a plan view of a guard according to the invention; FIG. 1 is a semi-transparent top view of a guard according to the invention; Figure 2 is a plan cross-sectional view of a guard according to the invention; FIG. 1 is a semi-transparent plan view of a guard according to the invention; FIG. 5 is a semi-transparent side view of a retractor and a guard according to the present invention. FIG. 5 is a side cross sectional view of a retractor and a guard according to the present invention. Figure 2 is a cross-sectional plan perspective view of a retractor and a guard according to the present invention. Figure 2 is a cross-sectional plan perspective view of a retractor and a guard according to the present invention. FIG. 5 is a semi-transparent plan perspective view of a retractor and a guard according to the present invention. FIG. 1 is a side view of a guard according to the invention. Figure 2 is a plan view of a guard according to the invention; FIG. 5 is a top perspective view of a retractor and a guard according to the present invention. FIG. 5 is a plan view of a retractor and a guard according to the present invention. Figure 2 is a bottom perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a bottom perspective view of a guard according to the invention; Figure 2 is a plan view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; Figure 2 is a bottom perspective view of a guard according to the invention; Figure 2 is a plan view of a guard according to the invention; Figure 2 is a plan perspective view of a guard according to the invention; FIG. 1 is a top perspective view of a two-piece guard according to the invention. Fig. 2 is a top perspective view of a blade guard according to the invention; Fig. 2 is a cross-sectional plan perspective view of a blade guard according to the invention; FIG. 5 is a cross-sectional view of a blade receiver of a blade guard according to the invention. Figure 2 is a bottom perspective view of a blade according to the invention; Figure 2 is a plan perspective view of a blade according to the invention; FIG. 1 is an exploded plan perspective view of a blade guard assembly according to the present invention. FIG. 1 is a top perspective view of a blade guard assembly according to the present invention. FIG. 1 is a cross-sectional plan perspective view of a blade guard assembly according to the present invention. FIG. 1 is an exploded plan perspective view of a blade guard assembly according to the present invention. FIG. 1 is an exploded plan perspective view of a blade guard assembly according to the present invention. FIG. 1 is a cross-sectional plan perspective view of a blade guard assembly according to the present invention. FIG. 1 is a cross-sectional plan perspective view of a blade guard assembly according to the present invention. FIG. 5 is a bottom view of a blade guard assembly according to the present invention. FIG. 1 is a cross-sectional plan perspective view of a blade guard assembly according to the present invention. FIG. 5 is a bottom perspective view of a blade guard assembly according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 1 is a top perspective view of a tissue grasper and morcellator according to the invention. FIG. 5 is a side cross-sectional view of the handle of the tissue grasper according to the present invention. FIG. 5 is a side cross-sectional view of the distal end of a tissue grasper according to the present invention. FIG. 5 is a cross-sectional plan perspective view of the distal end of a tissue grasper according to the present invention. FIG. 5 is a side cross-sectional view of the distal end of a tissue grasper according to the present invention. FIG. 1 is a top perspective view of a morcellator according to the invention. FIG. 2 is a bottom perspective view of a morcellator according to the invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 5 is a plan view of a storage bag in a roll-up configuration according to the invention; FIG. 5 is an end view of a storage bag in a rolled up configuration according to the present invention; FIG. 1 is an end view of a storage bag according to the invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall, a tissue sample inside a storage bag, and a tissue guard according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 5 is a plan view of an open storage bag according to the present invention. FIG. 6 is a cross-sectional view of a ring of a storage bag according to the invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall, a tissue sample inside a storage bag, and a tissue guard according to the present invention. FIG. 6 is a side cross-sectional view of a body wall, tissue specimen inside a storage bag rolled up around a bag ring, and a tissue guard according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 5 is a plan view of an open storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. 1 is a plan view of a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall, a tissue sample inside a storage bag, and a tissue guard according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 142B is a cross-sectional view of the storage bag according to the present invention taken along line 142B-142B of FIG. 142A. FIG. 5 is a cross-sectional view of an inflated storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall, a tissue specimen inside an inflated storage bag, and a tissue guard according to the present invention. FIG. 1 is a side view of a storage bag according to the invention. FIG. 144B is a cross-sectional view of the storage bag according to the present invention taken along line 144B-144B of FIG. 144A. FIG. 5 is a cross-sectional view of an inflated storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a body wall and a tissue sample inside a storage bag according to the present invention. FIG. 6 is a side cross-sectional view of a body wall and a tissue specimen inside an inflated storage bag according to the present invention. FIG. 6 is a side cross-sectional view of a body wall and tissue specimen inside an inflated storage bag pulled upward according to the present invention. FIG. 5 is a side cross-sectional view of a body wall, a tissue specimen inside an inflated storage bag, and a tissue guard according to the present invention. FIG. 1 is a side view of a guard according to the invention. FIG. 5 is a plan view of a bottom view of a guard according to the invention; Figure 2 is a plan view of a guard according to the invention; FIG. 1 is a side view of a guard according to the invention. FIG. 1 is a side view of a guard according to the invention. Figure 2 is a plan view of a guard according to the invention; FIG. 1 is a top perspective view of a molaration and bag system according to the invention. FIG. 1 is a top perspective view of a power molcerator according to the present invention. FIG. 5 is a top perspective cross-sectional view of a power molcerator according to the present invention. FIG. 2 is a cross-sectional view of a power molcerator according to the present invention. FIG. 2 is a cross-sectional view of a power molcerator according to the present invention. FIG. 1 is a top perspective view of a sample receptacle according to the present invention. FIG. 1 is a top perspective cross-sectional view of a bag tube and a bag according to the present invention. FIG. 5 is a top perspective cross-sectional view of the storage bag in an open configuration according to the present invention; FIG. 5 is a top perspective cross-sectional view of the storage bag in a closed configuration according to the invention; FIG. 5 is a top perspective cross-sectional view of the storage bag in an open configuration according to the present invention; FIG. 5 is a top perspective cross-sectional view of the storage bag in a closed configuration according to the invention; FIG. 5 is a top perspective cross-sectional view of the storage bag in an open configuration according to the present invention; FIG. 5 is a top perspective cross-sectional view of the grasper and storage bag of the open configuration according to the invention; FIG. 5 is a top perspective cross-sectional view of a storage bag rolled about a grasper according to the present invention. FIG. 5 is a top perspective cross-sectional view of the storage bag in an open configuration according to the present invention; FIG. 5 is a top perspective cross-sectional view of the storage bag in a closed configuration according to the invention; FIG. 5 is a top perspective cross-sectional view of the storage bag in an open configuration according to the present invention; Figure 2 is a plan view of a guard according to the invention; FIG. 5 is a side view of a guard attached to a morcellator shaft according to the invention. FIG. 5 is a plan view of a guard attached to a morcellator shaft according to the invention. FIG. 6 is a side cross-sectional view of a guard and storage bag attached to a morcellator shaft according to the present invention. FIG. 5 is a cross-sectional plan view of a guard attached to a molserator shaft according to the invention. FIG. 5 is a side cross-sectional view of a guard attached to a morcellator shaft according to the invention. FIG. 5 is a top perspective cross-sectional view of a bag tube and a storage bag with an upper opening according to the invention; FIG. 6 is a side cross-sectional view of a storage bag with a bag tube and side openings according to the invention. FIG. 6 is a side cross-sectional view of a storage bag with a bag tube and side openings according to the invention. FIG. 5 is a side view of a tissue sample inside a storage bag according to the present invention. FIG. 5 is a side cross-sectional view of a tissue sample inside a storage bag attached to a morcellator according to the present invention. FIG. 5 is a plan view of a storage bag attached to a morcellator according to the present invention. FIG. 1 is a side cross-sectional view of a storage bag and morcellator system according to the present invention. FIG. 1 is a side cross-sectional view of a body wall, tissue specimen, storage bag, and morcellator system according to the present invention. FIG. 1 is a side cross-sectional view of a body wall, tissue specimen inside a storage bag, and a morcellator system according to the present invention. Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Figure 2 is a plan view of a shield according to the invention; FIG. 5 is a partial plan cross-sectional view of a shield in a locking configuration according to the invention; Figure 2 is a bottom perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Figure 2 is a plan view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; FIG. 5 is a partial plan view of a shield according to the invention. FIG. 5 is a partial plan cross-sectional view of a shield according to the present invention. Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Fig. 2 is a partial plan perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; 1 is a front perspective view of a shield according to the present invention. Figure 2 is a rear perspective view of a shield according to the invention; Fig. 2 is a top perspective view of a shield according to the invention; Figure 2 is a front view of a shield according to the invention; Figure 2 is a rear view of the shield according to the invention; Fig. 2 is a side sectional view of a shield according to the invention. FIG. 5 is a side cross sectional view showing a shield according to the present invention with a batten at the bottom or rear end of the shield. FIG. 1 is a top perspective view of a battenless shield in accordance with the present invention. Fig. 2 is a side sectional view of a shield according to the invention. FIG. 5 is a side cross-sectional view of the shield showing the direction of insertion in accordance with the present invention. FIG. 5 is a side cross-sectional view of the shield showing the direction of insertion in accordance with the present invention. FIG. 6 is a side cross-sectional view of a shield showing an undeformed expanded configuration according to the present invention. FIG. 5 is a side cross-sectional view of a shield showing a deformed reduced configuration according to the present invention. FIG. 5 is a side view of the user's finger inserted into the shield in accordance with the present invention; FIG. 5 is a side cross-sectional view of an introducer inside a shield in accordance with the present invention.

  The following description is provided to enable one of ordinary skill in the art to make and use the surgical tools described herein, as well as perform the method, and the inventors have implemented the invention. Describe what you think is the best form to do. However, various modifications will still be apparent to those skilled in the art. These modifications are intended to be within the scope of the present disclosure. Different embodiments or aspects of such embodiments are shown in the various drawings and will be described throughout the specification. However, although shown or described separately, it is noted that each embodiment and aspect thereof can be combined with one or more of the other embodiments and aspects unless explicitly indicated. I want to. The reason for not explicitly describing each combination is merely to make the specification easier to read.

  Referring now to FIG. 1, a closed molaration procedure according to the present invention is shown. A small incision is made at the patient's abdominal wall 10 and traverses the abdominal wall 10 through the opening 14 to access the body cavity 12. Using a laparoscopic technique and instruments such as trocars, laparoscopes, graspers and scalpels, create single-site openings, scout target tissue, and ablate target tissue from surrounding tissue structures Can. Additional incisions or access sites can be used to insert instruments and scopes to facilitate the procedure. After the target tissue 16 such as at least a portion of the uterus in hysterectomy is completely abraded, the specimen collection bag 18 is inserted through the opening 14 of the abdominal wall 10 and placed inside the body cavity 12. The bag 18 can be delivered through a trocar or cannula disposed across the abdominal wall 10. The bag 18 is deployed and oriented inside the body cavity 12. Target tissue 16 is placed into the bag 18 through the opening 20 of the bag 18. Various types of bags 18 can be used. The bag 18 can be transparent so that the contents can be viewed from the outside of the bag 18 through a scope placed into the body cavity 12 through the secondary incision site of the abdominal wall 10. The contents of the bag 18 can be illuminated from the outside of the bag 18. The position of the target tissue 16 can also be observed through the transparent bag 18 to confirm the progress of the molaration, as well as the position and proximity of the target tissue 16 to the opening 14. Also, observe the bag 18 through the secondary site incision to check the condition of the bag 18 and ensure that the bag is not entangled or twisted, and that the specimen is directed towards the opening without dragging the bag 18 together. Make sure that they are moving (if dragged together, the bag may accidentally cut into contact with the blade). An opaque bag 18 can also be used. The material of the bag 18 is also important. Generally made of plastic, the bag is strong enough to withstand pull and strong pull, sufficiently stretchable, relatively thin and flexible, and resilient to puncture and tear There is. The bag is folded and reduced in size so that it can be inserted through a small incision / trocarr of approximately at least 5 mm in diameter. Also, when unfolded, the bag receives a large tissue piece and extends through the opening 14 to the surface of the abdominal wall 10, as shown in FIG. 1, sufficient for the instrument, scope, morsator 24 and surgical scalpel 26. It is large enough to form a large working space inside the bag 18. The bag 18 includes a tether or drawstring 22 that is configured to tighten to close the opening and to open the bag 18. The bag 18 withstands the gas injection pressure and does not leak. The whole system, part of the system or a combination of systems and / or components thereof are included in the morcellation system, arranged to provide storage of objects to be molated according to various embodiments of the invention Various examples of bags for incorporation, and devices for insertion, deployment and / or removal of bags are described in US patent application Ser. No. 08 / 540,795 (filed October 11, 1995); No. 549, 701 (filed on October 16, 2006): No. 11/549, 971 (filed on October 16, 2006): No. 12/902, 055 (filed on October 11, 2010); No. 13 / 252,110 (filed October 3, 2011), the entire disclosures of which are incorporated by reference as if fully set forth. And if it as is incorporated herein. Additional bag variations are described in more detail later herein.

  Once the target tissue 16 has been placed inside the bag 18, the tether 22 is grasped with a hand or laparoscopic grasper and at least a portion of the bag 18 is pulled through the abdominal wall opening 14. Pull on the tether 22 to close the bag opening 20. Before pulling the bag 18 through the opening 14, the initial incision can be as large as approximately 15-40 mm. If the target tissue 16 is too large to pass through the opening 14, the target tissue 16 will seat inside the body cavity 12 below the abdominal wall 10. The remaining portion of the bag 18, including the opening 20 of the bag 18, is withdrawn through the abdominal wall opening 14 and extends through the opening 14 along the upper surface of the abdominal wall 10 outside the patient, as shown in FIG. The bag 18 can be rolled down and / or pulled with a pin across the surface of the abdominal wall 10 to maintain its position and provide a degree of tissue retraction in the opening 14.

  The guard 28 is inserted through the opening 20 of the bag 18. The guard 28 has a diameter within the incision / opening 14 such that the guard 28 is held in place when disposed within the opening 14. The guard 28 can also retract tissue at the incision / opening, so it is called a retractor. One variation of the guard 28 is shown in FIGS. 2 to 6 and another variation is shown in FIGS. Guard 28 includes an inner surface 30 and an outer surface 32 that define side walls interconnecting top 34 and bottom 36. The inner surface 30 defines a central lumen 38 extending between the top 34 and the bottom 36. The inner surface 30 includes a curved funnel portion near the upper portion 34, which may be convex or frusto-conical. The guard 28 includes a top circumferential flange 40 and a bottom circumferential flange 42, which extend radially outward to form surfaces for seating against the upper and lower surfaces of the abdominal wall 10, respectively. The upper flange 40 can include hole-like features for securing the guard 28 to the bag 18 through the tether 22. The guard 28 has a total length of about 2.5 inches, but various lengths of guard 28 can be used depending on the thickness of the tissue wall 10 being penetrated. Guards 28, such as telescoping guards 28, having variable lengths are within the scope of the present invention. The inner diameter of the guard 28 at the longitudinal middle is approximately 1.3 inches and can be as small as 0.6 inches. The outer diameter of the guard 28 at the mid-longitudinal portion is approximately 1.6 inches and follows the incision / opening, and the upper circumferential flange 40 has a diameter compared to the diameter of the guard 28 at the mid-longitudinal portion It is designed to be held in place as it is large. The wall thickness at the longitudinal middle is approximately 0.16 inches and can be as thick as approximately 0.3 inches. The guard 28 is made of any polymer, such as KRATON® or polyethylene, but the guard can be made of any suitable material including metal. The guard 28 can be flexible so that it can be slightly compressed for easy insertion through the opening 14 of the abdominal wall 10. The thickness of the guard 28 and / or the choice of material for the guard 28 is chosen such that the guard 28 can withstand the cutting and piercing forces from blades, knives, scalpels, morserators and the like. The guard 28 serves as a cutting board, ie a surface on which the target tissue is placed in abutment for cutting before removal. The target tissue 16 is grasped by a laparoscopic grasper and pulled upward towards the opening 14. At least a portion of the target tissue 16 which is then cut is held in place at any position along the length of the guard 28. A blade, such as a scalpel or morsator, is then moved to contact the portion of the target tissue to be cut within the position of the guard 28 and cut the target tissue portion. The cut target tissue portion is pulled through the opening 14 to the surface external to the patient, and a new portion of the target tissue to be cut and removed is brought along the guard 28 into place. This process is repeated until the entire sample is removed from the bag 18 whole or in part. The guard 28 acts as a protection for the bag 18. Because the practitioner can freely cut the target tissue within the position of the guard 28 or even against the inner surface 30 of the guard, the result is that the bag 18 may be torn apart with a scalpel or molserator. It is reduced. The guard 28 not only protects the sample collection bag 18 from accidental incision, but the guard 28 protects surrounding tissue such as the abdominal wall from accidental incision. The guard 28 preserves the integrity of the bag 16 and effectively maintains the closed molaration system. The surgeon can quickly and safely reduce the sample and remove it from the abdominal cavity.

  Once the guard 28 is deployed, the surgeon grasps the specimen 16 and pulls it through the incision as far as possible. The surgeon then initiates the mole serration of the specimen 16 with the scalpel 26 and cuts the specimen 16 to reduce its size. Ideally, the surgeon "coring" or "pealing" the specimen 16 to keep it in one piece as much as possible. However, if anything, the specimen 16 is often subdivided into multiple pieces. Since the surgeon can maintain the pneumoperitoneum in the abdominal cavity 12 while molesting through the incision, the progress of the molaration can be laparoscopically through the side port into the abdominal cavity 12 located at the secondary site. It can be observed below. The side port is located outside the bag 18 and the surgeon can see through the clear bag or look at the bag itself to ensure that it maintains integrity . Once the specimen 16 has been molarized, crushed and shrunk enough to pull the remaining part through the incision, the guard 28 is removed and the bag 18 and its contents are removed from the pieces produced during Include and pull out of the patient. The bag 18 maintains a closed system to prevent the remaining small pieces from being left behind in the abdominal cavity 12, whereas in conventional molseration, the surgeon potentially removes a new tumor site. In order to prevent seeding, the pieces that come back into the pelvic cavity must be carefully located and recovered. The surgeon may choose to have a laparoscopic final observation of the patient and then close the wound.

  Although abdominal removal and molaration has been described, the above procedure can be performed similarly through the vaginal orifice if the neck is removed. Following the same process, the bag 18 is inserted and the specimen 16 is placed laparoscopically into the bag 18. The tether 22 will pull through the vagina rather than pulling through the abdominal wall opening 14. Similarly, the specimen 16 will be seated at the base of the vagina while the bag 18 is released outside the patient through the vagina. The surgeon can roll down the bag 18 or pull on the pin to maintain its position and provide some degree of retraction. The surgeon places the guard 28 transvaginally to protect the integrity of the bag 18 and maintain a closed system, grasp the sample 16 and lift it, and morselate to reduce the size of the sample 16 . Analsis of the analyte is performed at the location of the guard 28 and / or against the surface of the guard 28 to protect the bag and surrounding tissue from inadvertent dissection. The surgeon can maintain pneumothorax and monitor the progress of the morsation laparoscopically. Once the specimen 16 has been morsified, crushed and shrunk enough to withdraw the remaining part through the vagina, the guard 28 is removed and the bag 18 and its contents, including the pieces produced during the morseration, are removed. , Pull out of the patient. The bag 18 maintains a closed system to prevent it from being left behind in the small piece abdominal cavity and to prevent harmful substances such as cancer cells from being scattered in the abdominal cavity, which is different from the prior art. In morseration, the surgeon must come back and carefully search for and retrieve pieces scattered in the pelvic cavity and seek out pieces in the pelvic cavity. The surgeon can choose to have a laparoscopic final observation of the patient, closing the vaginal cuff and the abdominal incision.

  In one variation shown in FIG. 11, the guard 28 is configured to attach to a cap 44, such as a GELSEAL® cap manufactured by Applied Medical Resources Corporation of California. The cap 44 includes a rigid ring 46 removably connectable to the proximal end of the guard 28. The cap 44 includes a lever 48 for locking the cap 44 to the guard 28. The cap 44 includes a penetrable portion 50, which can be made of a gel, which is configured to seal against an instrument inserted therethrough and to maintain the pneumothorax inside the abdominal cavity. 12-13 show the cap 44 connected to the guard 28. FIG. A gas injection port 52 can be provided in the cap 44. The cap 44 can be snapped onto the guard 28 and sealingly locked there with the lever lock 48 so that the insufflation is maintained. FIG. 14 shows a cap 44 having a plurality of ports 54. Each port 54 is configured to receive a laparoscopic instrument and includes one or more internal seals for sealing against the inserted instrument. The multiport cap 44 advantageously allows for the insertion of a grasper, laparoscope and / or morcellator through a single site.

  15-17 illustrate another variation of the guard 28 that includes a balloon 56 at the distal end of the guard 28. FIG. The balloon 56 is shown in an inflated configuration in FIG. In the inflated configuration, the balloon 56 extends radially outward to form a wide flange for securing against the abdominal wall 10 inside the abdominal cavity 12, making it difficult for the guard 28 to be inadvertently removed from the opening 14. FIG. 16 shows the balloon in a contracted configuration, in which the guard 28 is easily inserted into and removed from the opening 14. The guard 28 of FIGS. 15-17 can also be connected to the cap 44. The guard 28 can be made of any polymeric material, including polycarbonate or similar materials.

  The funnel shaped inlet at the proximal end of the guard 28 is described above. The funnel shaped inlet can expand radially outwardly in another variation to form a larger surface area where tissue can abut and cut. The flared proximal end also assists in holding the bag in place outside of the patient and between the guard 28 and the tissue edge 10. In another variation, the guard 28 includes a frusto-conical or curved shaped flared distal end. The flared distal end can include an enlarged, radially extending flange that spreads the bag 18 laterally inside the abdominal cavity. The flared distal end keeps the bag in the open position and helps to keep the bag from touching the specimen and away from the distal entrance of the guard 28, thereby causing the bag 18 to be inadvertent Protect from contact with the blade. In a variation of the flared distal end of the guard 28, the distal diameter of the guard 28 at the distal opening is larger than the diameter of the guard 28 at the longitudinal middle. In a variation of the flared proximal end of the guard 28, the proximal diameter of the guard 28 at the proximal opening is larger than the diameter of the guard 28 at the longitudinal middle. In yet another variation, the guard 28 includes a flared proximal end and a flared distal end, retaining both of the benefits described above.

  A method for removal of tissue using guard 28 with cap 44 is now described. After completion of the laparoscopic hysterectomy or other incision, the aforementioned specimen 16 is completely peeled from the surrounding tissue and awaiting removal. The surgeon inserts the specimen bag 18 (which may be transparent) into the pelvis and places the specimen 16 in the bag 18. The surgeon then grasps the tether 22 of the bag 20 with a laparoscopic grasper and pulls the bag 18 through the abdominal wall incision 14 in which the trocar has previously been placed. If necessary, the surgeon extends the incision to 15-25 mm before pulling up the bag all the way. Because the specimen 16 is too large to pass through the opening 14, the specimen 16 will be seated within the pelvic cavity just below the abdominal wall 10, while the remainder of the bag 18 is as shown in FIG. It is pulled out of the incision and opened outside the patient. The surgeon can roll down the bag or pull on the pin to maintain its position and provide some degree of retraction. The surgeon then inserts a guard 28 into the incision to protect the bag 18 and the abdominal wall 10 and to retract the incision during molaration. Bag integrity is maintained and a closed system is maintained.

  The guard 28 is disposed within the opening 20 of the bag 18 and positioned within the incision so that the guard 28 extends across the tissue edge 10. The cap 44 is connected to the guard 28. The cap 44 snaps onto the proximal upper flange 40 and moves the lever 48 of the cap 44 into the locked position to seal the cap 44 on the guard 28. The guard 28 can include reinforcing wires 58 to maintain the shape and stiffness of the top flange 40. The wire 58 can be seen in FIGS. 1, 5-6, 10 and 12. With the cap 44 in place, the bag 18 can be gassed. In one variation, only the bag 18 is insufflated into the abdominal cavity 12. In another variation, both the bag 18 and the abdominal cavity 12 are insufflated. In another variation, both the bag 18 and the abdominal cavity 12 are insufflated such that the pressure inside the bag 18 is greater than the insufflation pressure of the abdominal cavity 12. Gas injection can occur through a trocar inserted through cap 44 or through gas injection port 52 of cap 44. With the cap 44 in place, the powered morselator 24 is inserted inside the bag 18 through the penetrable portion 50 of the cap 44. Alternatively, if multiport cap 44 is used, morcellator 24 can be inserted through one of the ports 54. A surgical grasper is also inserted either through the penetrable portion 50 or through one of the ports 54 and through the cap 44 to grasp the target tissue and guard proximally towards the opening The 28 central lumens 38 are drawn where the target tissue is morseled within the protected zone provided by the guard 28. As mentioned above, the guard 28 protects the bag 18 from puncture and thereby assists in the maintenance of the closed molaration system. The power molserator 24 is positioned through the gel cap 44 at a depth such that the bladed distal end 60 of the power molserator 24 is maintained within the central lumen 38 and within the protected area or length of the guard 28. Ru. The target tissue is drawn toward blade 60 by grasper for morsulation and removal. The removed tissue travels through the central lumen of the powered morcellator 24.

  Instead of placing the molserator 24 through the penetrable part 50 of the cap 44, a stabilizer is provided, which works with the bag 18 or the guard 28 to protect the molserator 24 inside the central lumen 38 of the guard 28 It plays the role of holding in place at a depth within the zone. Maintaining the morcellator in the lumen 38 of the guard 28 prevents the morcellator 24 from contacting the wall of the bag 18 during the procedure, thereby preventing the bag from being torn inadvertently. Variations of the stabilizer will be described further below.

  After placing the morcellator 24 and cap 44, the surgeon may choose to insufflate the bag 18 as well as the abdominal cavity 12. The surgeon can observe the position of the morcellator 24 and the target tissue 16 as well as the integrity of the bag 18 to ensure that the bag is not kinked or too close to the distal end 60 of the morcellator 24. The observation is made through a laparoscope placed through port 54 at the same incision site or through a secondary incision providing a side port. The specimen 16 is grasped with a tenaculum and pulled through a powered molarator 24 to reduce its size. Ideally, the surgeon "coring" or "peeling" the specimen to keep it as one piece as possible. However, if anything, the specimen 16 is often subdivided into multiple pieces. Once the specimen 16 is sufficiently molared to withdraw the remaining tissue through the incision, remove the morcellator 24, the gel cap 44 or stabilizer, and the guard 28 retractor while the bag 18 and its contents are being morcellated. Pull out of the patient, including the resulting piece. The bag 18 maintains a closed system to prevent the remaining small pieces from being left behind in the abdominal cavity 12, whereas in conventional molseration the surgeon comes back and You have to carefully search and collect pieces scattered inside. The surgeon may choose to have a laparoscopic final observation of the patient and then close the wound.

  Although abdominal removal and molaration has been described, the powered molaration procedure can be performed similarly through a bodily orifice such as the vagina. Following the same process, the bag 18 is inserted and the specimen 16 is placed laparoscopically in the bag 18. The tether 22 will pull the tether 22 through the vagina rather than pulling it through the abdominal wall opening 14. Likewise, the specimen 16 will be seated at the base of the vagina while the bag 18 is released outside the patient through the vagina. The surgeon can roll down the bag or pull on the pin to maintain its position and provide some degree of retraction. The surgeon places the guard 28 transvaginally into the bag 18 to protect the integrity of the bag and maintain a closed molaration system, places the cap 44 on the guard 28 and either the gel cap 44 or the stable Place the power molserator 24 through the capping cap. The surgeon then grasps the specimen 16 with the support scissors and withdraws it vaginally through the powered morcellator 24 to reduce the size of the specimen 16. The surgeon maintains the insufflation and observes the progress of the molseration laparoscopically. Once the specimen 16 has been sufficiently molared to withdraw the remaining tissue through the vagina, the molcelerator 24, the gel cap 44 or the stabilizing cap, the guard 28 and / or the retractor are removed and the bag 18 and its contents are Pull out of the patient, including the pieces created during the molaration. The bag 18 maintains a closed molseration system to prevent the remaining small pieces from remaining in the abdominal cavity 12, whereas in conventional molseration the surgeon comes back and the pelvis The pieces in the cavity must be carefully located and recovered. The surgeon may choose to have a laparoscopic final view of the patient, closing the vaginal stump and the abdominal incision.

  Referring now to FIGS. 18-19, a retractor 62 is shown having a first ring 64 and a second ring 66 interconnected by flexible side walls 68. The retractor 62 is described in more detail in one or more of the cited documents incorporated by reference into the present application. The second ring 66 can be compressed and inserted through the small incision where it expands to contact the abdominal wall 10 inside the cavity 12 to form a securement. The first ring 64 is external to the patient and above the abdominal wall 10 where it can be rolled down to retract and enlarge the opening 14 in the abdominal wall. The retractor 62 can be used with any of the variations described above. In use, the retractor 62 is inserted prior to inserting the bag 18 into the cavity or orifice. In one variation, as shown in FIG. 19, the first ring 64 has a larger diameter than the second ring 66. The first ring 64, which is larger than the second ring 66, allows more space for work and cutting tissue adjacent to it. Sidewall 68 is made of a polyurethane laminate or similar material that includes a woven material that is resistant to cutting through sidewall 68.

  20A-20B show a modified retractor 62 configured as a bag 70. FIG. The bag 70 includes a first ring 64 and a second ring 66 interconnected by flexible substantially cylindrical side walls 68. The opening of the second ring 66 is closed by the depending bag portion which forms the base 72 of the bag 70. The bag 70 is inserted and used in the same manner as described above for the bag 18. The second ring 66 is compressed and placed into the abdominal cavity 12 through a small incision. The side wall 68 is rolled around the upper ring 64 to retract and expand the opening 14 and the guard 28 connectable to the first ring 64 is also used at the opening inside the bag 70, It may not be used. Analyte 16 is removed manually or through a powered molarator in the same manner as described above. The first ring 64 is also connectable to the gel cap 44.

  Referring now to FIGS. 21-24, a bag 70 having only a first ring 64 forming an opening, a flexible cylindrical side wall 68 and a base 72 is shown. The first ring 64 is resilient and compressible into a collapsed elongated configuration suitable for passing through a small incision or through the lumen of the trocar. The arrows in FIG. 22 indicate the longitudinal direction in which the bag 70 is crushed. The crushed bag 70 is then subsequently easily compressed laterally and deployed in the abdominal cavity. The first ring 64 is compressed into an elongated shape. The compressed bag can form the original shape of the first ring 64 expanded. In the expanded configuration, the bag 70 is easily oriented within the cavity 12. The collapsed bag 70 is conveniently placed flat inside the abdominal cavity and includes two sides. The bag 70 does not have the front side to be on in the collapsed configuration, as either side can be used to position the specimen within the boundaries of the first ring 64. The first ring 64 serves as a perimeter guide for specimen placement and can be made bright in color so that it can be easily observed laparoscopically. After placing the specimen within the outer circumference of the first ring 64, the first ring 64 is grasped and lifted to place the specimen inside the bag 70. The same is true for the two-ring bag 70 described above. As shown in FIGS. 23-24, the bag 70 can be twisted to form a spiral configuration to crush or shorten the length of the bag. This feature is not only advantageous for inserting the bag through the small incision, but also for lifting it close to the opening of the bag as it is being morsified.

  Referring now to FIG. 25, a guard 74 is shown configured for use with the retractor 62 shown in FIGS. 18-19 or with the bag 70 of FIGS. The guard 74 includes a rigid ring 76 having a plurality of inwardly extending flaps 78 meeting at the center or forming an opening 80 at the center as shown in FIG. The flap 78 is attached to the ring 76 so as to bend relative to the ring 76, allowing the target tissue 16 to be removed past the flap 76. The flaps 78 also bend distally to allow the instrument to be inserted through the guard. The flaps 78 are made of the same material as the guard 28, for example polycarbonate, LDPE, HDPE or similar material, so the flaps 78 are sufficiently elastic, cut resistant and resist penetration of the blade, thereby Protect the retractor 62 or the bag 70. The guard 74 may comprise a single ring 76 having flaps 78 or may be comprised of two similar rings 76a, 76b each having flaps 78a, 78b. The two rings 76a, 76b are connected together such that the flaps 78a are offset from the flaps 78b, resulting in a stacked flap structure providing protection between the flaps 78a and 78b. The target tissue 16 is pulled through the openings 80a, 80b, and when within the area of the guard 76, the target tissue 16 is cut. The target tissue 16 can also be cut when positioned against the flaps 78a, 78b.

  Referring now to FIG. 26, the guard 74 is configured with an upstanding flat outer peripheral wall 82 configured to be snapped under the first ring 64 of the retractor 62 or bag 70 as shown in FIG. Including. The guard 74 may also include a flange 84 configured to snap onto the first ring 64 of the retractor 62 or bag 70, as shown in FIG. FIG. 27 shows a rigid guard 74 without flaps. The rigid guard 74 of FIG. 27 provides a large cutting surface that can position and cut target tissue without bending as much as the guard 74 with the flexible flaps 78. The guard 74 can also include a funnel-shaped depending portion 86 to provide greater protection in the longitudinal direction against the bags / retractors 70, 62 and / or the wound. The guard 74 is disposed at the top of the retractor 62 or bag 70 and within the outer circumference of the first ring 64. The guard 74 is then snapped under the first ring 64 to join the guard 74 to the first ring 64. The guard 74 also assists in keeping the bag 70 or retractor 62 in place while being made of a material that resists penetration when being morsulated. In another variation, the guard is configured to snap onto the ring.

  Referring now to FIG. 30, a trocar 88 having a first balloon 90 and a second balloon 92 is shown. Trocar 88 includes a removable seal housing 94 that houses one or more seals for sealing against the inserted instrument. Trocar 88 includes a central lumen 96 extending through seal housing 94 and trocar 88. The lumen 86 is sized and configured to receive the power molserator 24. Trocar 88 can further include an obturator (not shown) configured to penetrate the abdominal wall. The trocar 88 can be inserted through the gel cap 44 described above or directly through the abdominal incision. The bags 18, 62 can be deployed through the lumen 86 and the specimen 16 is inserted into the bags 18, 62. The tether 22 of the bag 18 or the first ring of the bag 62 is pulled through the incision and the trocar 88 is reinserted. The second balloon 92 is inflated. In the inflated configuration, the second balloon 92 extends laterally to push the bags 18, 62 laterally and out of the path of the distal end of the trocar 88 away from the bladed end of the morcellator. . The power molserator 24 is inserted into the lumen 96 of the trocar 88. A stop formed on the trocar 88 can prevent the molserator 24 from extending beyond the distal end of the trocar 88, which abuts the molserator 24 to move it distally. It will prevent. A support rod is inserted into the lumen of morcellator 24 to grasp the tissue and pull it towards the morcellator. The tissue is cut and removed from the sample bag. The first balloon 90 is inflated, which is above the abdominal wall. Both the first balloon 90 and the second balloon 92 help hold the trocar 88 in place relative to the abdominal wall 12. FIG. 31 shows another trocar 88 having a seal housing 94 and a gas injection port 98 for inflating at least one balloon 92.

  The stabilizer 100 will now be described with reference to FIGS. 32-39. Stabilizer 100 includes a flange 102 configured to connect with bag 18, 70 or guard 28. Stabilizer 100 includes a central portion 104 that defines a lumen 106 and accommodates lock 108. The lumen 106 is sized and shaped to receive the power molserator 24. Once inserted into the lumen 106, the height of the morcellator 24 relative to the abdominal wall can be adjusted and then locked in place by the lock 108. The lock 108 has a locking release configuration that allows the morcellator 24 to translate longitudinally within the lumen 106 when the lever 110 is released. The lock 108 also has a locking arrangement in which the lever 110 is depressed to lock the translation of the morcellator 24. The lock 108 operates to increase the friction on the morcellator 24 shaft to hold it in its predetermined position.

  Referring now to FIGS. 40-41, the stabilizer 100 is shown connected to the motive morsator 24. The system of FIGS. 40-41 includes a toothed bar on the morcellator 24 configured to engage a pawl (not shown) inside the central portion 104 of the stabilizer 100. A button 114 for unlocking and engaging is shown on the stabilizer 100, which unlocks and locks the stabilizer 100 from the molarator 24 to free its relative longitudinal translational movement. Or for restraint. The molserator 24 includes an integrated scope and illuminator 116, a gas injection port 118, and a mechanical drive connection 120 for rotating the molser blade 122. The stabilizer 100 includes a lower flange 102 which extends outwardly to engage the bag or retractor or guard as described above. In one variation, the stabilizer 100 is configured with a safety shut-off mechanism so that startup of the morcellator 24 is prevented if the stabilizer's pawl is within a certain range of the toothed bar 112. The molserator 24 is not triggered when it is in a position too distal or when it exceeds the range of the guard and thus may inadvertently contact the bag. Another variation of stabilizer 100 is shown in FIGS. 42-43, where like numerals are used to describe like parts. In FIG. 43, the stabilizer 100 has a different shape and the pawl element 122 is visible.

  44-45 show a bag 18 having a tether 22 and a flexible ring 64 at the opening 20. FIG. The bag material can be transparent or opaque, and the ring 64 is compressible for insertion through the small incision. The side wall 68 can be rolled around the first ring 64 to reduce the height of the bag, thus lifting the specimen closer to the opening, which makes the specimen more accessible for molaration.

  46-47 show a bag deployment device 124 for the bag 18 of FIG. The device 124 can be inserted through the trocar. The bag 18 includes an opening 20, a tether 22 and a deployment cap 21.

  48-49 illustrate another bag variation having a first ring 64, a second ring 66, side walls 68 therebetween and a base 72. FIG. A resilient second ring 66 located at the bottom of the bag 18 flares the bag when placed inside the body cavity 12 to prevent material from sticking to the specimen 16. After the sample is placed in the bag 18, the first ring 64 is pulled to the surface of the abdominal wall 10, as shown in FIG.

  FIG. 50 shows a bag 18 having a first ring 64 made of nitinol that allows for easy insertion through a small incision while providing support to keep the bag 18 open inside the abdominal cavity 12. Indicates

  50A-50D illustrate the bag 18 according to various embodiments in an uncrushed or expanded or partially expanded state. As shown, the bag 18 includes a closed end 126 and at least one open end 128. The open end 128 according to various embodiments comprises a tether or drawstring 130 surrounding the open end 128 of the bag 18. Operation of the tether 130 opens and closes the open end 128 of the bag 18. The bag 18 includes a plurality of pre-formed folds 132 or a predetermined deformation pattern on the wall 134 of the bag 18 between the closed end 126 and the open end 128 of the bag 18 as shown. The bag 18 according to various embodiments collapses the bag 18 into a flat state to provide a minimum height, with the open end 128 facing upwards or towards the opening of a body cavity, the maximum width, diameter or It has an opening dimension, is formed to tend to point the closed end 126 away from the opening in a body cavity, and is arranged to lie flat and stable along the body cavity. According to various embodiments, when the force is applied in one direction, the height of the wall 134 of the bag 18 increases to capture or surround the analyte in the bag 18. The creases 132 or deformation patterns ensure that the growth of the bag 18 occurs linearly in the direction in which the force is applied. According to various embodiments, a weight, specimen or opposite force is applied to the bag 18 to further assist in the increase of the bag 18 or, in particular, the linear direction of the bag 18.

  In one embodiment, the bag 18 is folded flat or in accordion form prior to deployment in the patient's body. When deployed, the bag 18 lays flat with the open end 128 of the bag 18 up and the closed end 126 down. The closed end 126 is placed, for example, on the bottom of the patient's body cavity. Thus, the open end 128 of the bag 18 remains open due to the pattern formed in the wall 134 of the bag 18, and thus does not need to be held open. Further, due to the pattern, the open end 128 is biased open and resists closing. The difficulty of placing the specimen on and / or in the bag and the time spent on it are thereby reduced.

  The surgeon places the specimen on the bag 18, on or over the open end 128 of the bag 18. By pulling on the tether 130, the wall 134 of the bag 18 is pulled up around the specimen, thereby storing the specimen. The opposing forces, i.e., the pull on the tether 130 and the weight of the sample on the bag 18 develop or extend a deformation pattern along the wall 134 of the bag 18. In one embodiment, the bottom or closed end 126 of the bag 18 may be a weight or to ensure that sufficient counter force is provided to extend the wall 134 of the bag 18 when the tie 130 is pulled. Includes attachable weights. In one embodiment, the force of pulling the bag 18 out of or towards the opening in the body cavity also unfolds the wall 134 of the bag 18 or one or more folds 132 of the wall 134 To provide one or more tabs 136, ie, the portion of the bag 18 surrounding the open end 128 of the bag 18.

  In one embodiment, when the weight of the specimen pulls the bag 18 downward, it pulls the short side of the bag 18 downward, reducing the total storage size. In various embodiments, one or more tabs 136 are provided on the open end 128 of the bag 18 on the flat side of the bag 18 to compensate or reduce the reduction in total storage size. Prevent total storage size from decreasing. Thus, in one embodiment, when the bag 18 flattens, the distance along the edge of the bag 18 is greater than the distance along the cross section of the bag 18. The tether 130 is threaded through the tab 136 in one embodiment.

  For the specific desired height and / or width of the bag 18, a pattern such as that shown in FIGS. 50E-50F is used to generate the optimal wall pattern for proper deployment and operation (eg, stretching and Guarantee the storage). In one embodiment, the bag 18 is preformed in the illustrated pattern, and the bag 18 is then heated to maintain a flat, patterned condition. The tether 130 is attached to or threaded through the tab 136 at the open end 128 of the bag 18. Therefore, heat, pressure or preforming conditions that bring the bag 18 into an initial flat and stable patterned state help maintain the deformation pattern, and when the bag 18 is placed inside the body cavity, This is crushed and deformed or biased. The downward force on the center of the bag 18 assists in stretching or unfolding the fold 132, thereby expanding or lengthening the height of the bag 18 to wrap the specimen. As shown, the valley and / or folds of the pattern can have the same height and / or width, further ensuring linear and constant or measured size increase. In various embodiments, the valleys and / or folds of the pattern may have different dimensions and exert an equal force on the inner wall of the cylindrical deployment device, which reduces the force required to deploy the bag 16.

  According to various embodiments, the top or open end and the bottom or closed end of the bag are alternately twisted to create a spiral pattern on the wall of the bag. The bag and / or spiral is heated or compressed to maintain its shape. Spiral folds help keep the bag flat after it is inserted into the body. After the sample is placed on the open end of the bag, pulling on the tether surrounding the open end of the bag will unroll or untwist the wall of the bag. Therefore, the force in the opposite direction, ie the pulling force on the open end of the tether or bag, and the weight of the weight attached or added to the closed end or bottom of the specimen and / or bag, cause the bag to As it is pulled up towards the opening inside, it untwists the bag and wraps the specimen. According to various embodiments, the open end comprises a first ring and / or the closed end comprises a second ring. The first and / or second ring may be reinforced or may include a wire or rod to bias the open end into an open or expanded state to receive the analyte and the bag may be flat or unexpanded Increase the tendency to remain present or provide weight to aid in bag expansion or stability in bag placement or sample reception and capture.

  According to various embodiments, the top or open end and the bottom or closed end of the bag are crushed directly towards one another. The creases or creases in the wall of the bag between the open and closed ends of the bag can be heated or compressed to maintain its pattern / shape and keep it flat after the bag is inserted into the body. Support. After the sample is placed on the open end of the bag, pulling on the tether surrounding the open end of the bag will stretch or straighten the creases in the wall of the bag. Therefore, the force in the opposite direction, ie the pulling force on the open end of the tether or bag, and the weight of the weight attached or added to the closed end or bottom of the specimen and / or bag, make The bag is stretched and wraps around the specimen as it is pulled up towards the opening inside. According to various embodiments, the open end comprises a first ring and / or the closed end comprises a second ring. The first and / or second ring may be reinforced or may include a wire or rod to bias the open end into an open or expanded state to receive the analyte and the bag may be flat or unexpanded Increase the tendency to remain present or provide weight to aid in bag expansion or stability in bag placement or sample reception and capture.

  As shown in FIGS. 50G and 50H, the bag 18 includes various tops, bases and whole including, but not limited to cubes, prisms, cylinders, spheres, dodecahedrons, hemispheres, cones, cuboids, polygons, etc. It may have a shape, surrounded by one or more openings, including various deformation wall patterns, which tends to cause the bag to remain in a collapsed or substantially flat shape, The specimen is expanded in a linear or controlled manner when manipulated to be contained and encased therein.

  The entire system, part of the system or combination of systems and / or components thereof are included in or incorporated into a molaration system arranged to provide channels and / or protected areas according to various embodiments of the present invention Various examples of the access system of U.S. Pat. No. 13 / 865,854 (filed on April 18, 2013); No. 61 / 880,641 (filed on September 20, 2013); No. 12 / 578,422 (filed on October 13, 2009); No. 61 / 104,963 (filed on October 13, 2008); No. 12 / 358,080 (filed on June 22, 2009) 11 / 374,188 (filed on March 13, 2006); 11 / 683,821 (filed on March 8, 2007); 12 / 396,62 No. 14/209, 161 (filed on March 13, 2014); No. 12/873, 115 (filed on August 31, 2010); No. 840, 989 (filed on July 21, 2010); No. 11/548, 758 (filed on October 12, 2006); No. 10/516, 198 (filed on November 30, 2004) No. 10 / 666,579, filed September 17, 2003, the entire disclosures of which are incorporated herein by reference as if fully set forth.

  Referring to FIGS. 51-53, another variation of the guard or shield 200 according to the present invention is shown. The guard 200 has a substantially spiral shape. Guard 200 includes a first inner end 202 and a second outer end 204. The first end 202 and the second end 204 are interconnected by a central portion 206, also called a leaf spring or band. The guard 200 is interconnected by an upper end 212, also referred to as a back or proximal end, and a bottom end 214, also referred to as a front or distal end, and by a first inner end 202 and a second outer end 204. And an inner surface 208 and an outer surface 210. The central portion 206 or band has a concave outer surface 210 and the inner surface 208 forms a convex following surface as viewed from within the spiral. The concave surface of the band is a parabola in one embodiment, and the inflection point is at the middle between the top end 212 and the bottom end 214, but the invention is not limited thereto, the inflection point is the top end 212 and It may be anywhere between the bottom end 214 and may coincide with or substantially coincide with the top end 212 or the bottom end 214. Band 206 may not have a concave surface, and may simply be a curved or straight line along at least a portion of guard 200 between top end 212 and bottom end 214. The guard 200 is shown as being symmetrical with its top end having the same outer diameter as the bottom end. In another variation, the guard 200 can be asymmetric in shape and have an upper end with a larger or smaller diameter than the bottom end. Although the guard 200 is vertically symmetrical, the invention is not limited thereto, and the guard 200 can have a central axis that is at an angle to a reference horizontal plane. The guard 200 has a spiral shape such that a portion of the band overlaps the other portion of the band in a curved, circular or elliptical fashion. Specifically, at least a portion of the outer surface 210 of the band 200 overlaps and faces at least a portion of the inner surface 208 of the band 200 so that the concave surface of one portion of the band 200 is the concave surface of the other portion of the band Adjacent or juxtaposed, one part of the band is seated and nested within the other part of the band. The spiral is shown to have a stationary, non-mechanically stressed configuration having one turn and a half and a circumferential length of approximately 3πR in circumferential length, where R is , The radius measured perpendicular to the long axis of the guard 200. The present invention is not limited to the guard 200 having exactly 1.5 turns, but its size, shape and desired force for functions such as specific incision size and retractor function and / or holding function. Depending on the distribution, one may have more or less turns, as desired. A particular advantage of the spiral guard 200 is that its shape and size can be changed, expanded or reduced. In essence, the band can slide against itself to form a large spiral form with a larger diameter or a smaller spiral form with a smaller diameter. Spiral guard 200 includes a central lumen 216 formed by a spiral, which can also expand when the spiral is expanded or opened. The size of the central lumen 216 also causes the band to slide tight on itself into a tight curl, resulting in a greater number of turns as compared to a larger curl (resulting in a smaller diameter with a smaller number of turns) Can be reduced when the spiral is closed or reduced in size. The central lumen 216 is substantially circular, although the invention is not so limited and the central lumen 216 can be oval or irregularly shaped. Therefore, the spiral shield 200 is adjustable as it is inserted into the patient's wound or incision or into a bag placed inside the patient, as described above for the other guards. Depending on the size of the incision, the spiral shield 200 can be adjusted larger or smaller by opening or closing the spiral shape and curling the guard on itself to make more turns Accordingly, it fits into the wound opening or bag accordingly. Additionally, the spiral shield 200 can be shaped to have a predetermined bias that is biased to a particular static or diametrical position, shape and size. For example, if an approximately 1-inch incision is made in the patient, a spiral shield 200 having a resting diameter of approximately 2 inches will twist the shield on itself to increase its turns, thereby reducing its diameter. By this, the size can be reduced. While in the reduced configuration, the spiral shield 200 is inserted into the 1 inch incision and then released. However, due to the bias molded into the spiral shield 200, the spiral shield 200 tends to be biased to its normal configuration and thus expand from its reduced configuration, advantageously simultaneously retracting the incision and cutting the incision It seals or exerts force on it to hold the spiral shield 200 and anything between the shield 200 and the incision, for example the bag, in position relative to the patient. Alternatively, the shield 200 can advantageously be reduced under the force of tissue when inserted into the incision. The force of the tissue on the shield can reduce the diametrical size of the shield. Because the shield is adjustable, the size of the central opening or lumen 216 can be increased by opening the spiral for removal of larger specimens. This adjustability advantageously reduces strain on the surrounding tissue, keeping the incision site as small as possible, reducing the risk of infection, and at the same time, spiraling when necessary to withdraw the specimen from the body. Opening allows the size of the incision to be retracted and enlarged. Sometimes the size of the tissue to be removed may not be predictable, and this adjustability advantageously allows for easy removal of a wider range of tissue samples without creating difficulties for the physician.

  The position of the spiral shield 200 is further advantageously held relative to the incision site or a natural orifice such as the vagina, with the aid of a curved or concave band. Specifically, the upper end 212 forms an upper lip, also referred to as an upper flange, which extends at least partially circumferentially on the upper surface of the tissue. The bottom end 214 forms a bottom lip or bottom flange, which extends at least partially circumferentially on the underside of the tissue inside the patient's body cavity, abdominal wall or surgical working space, advantageously The tissue is retracted away from the cutting surface of shield 200 (which is generally the inner surface 208 of the band). The tissue is received against the outer surface 210 of the band and seated within the concave or curved shape of the outer surface 210 to keep the shield and storage bag in place with the flange and the shield to slide down or slip up into the patient Prevent going out of the patient. Of course, the shield 200 is disposed directly within the surgical incision / orifice, or within any one or more of the storage bag and wound retractor described above. The molaration can be advanced in any technique or manner selected by the surgeon, including using the inner surface 208 of the shield 200 as a cutting board, to which the blade is used to center with the grasper The tissue drawn through or into lumen 216 can be cut. The tissue to be morsulated can be positioned against the inner surface 208 of the guard 200 when pulled up through the central lumen 216, and a blade or scalpel can be used to cut the tissue against the shield 200 . The shield 200 is made of any suitable material such as polymer or metal. One suitable material is ultra high molecular weight polyethylene plastic. Another suitable material is low density linear polyethylene. The shield material has a thickness optimized to protect the tissue without being punctured or torn when cutting tissue in contact therewith. When the molaration is complete, the spiral shield 200 can be reduced in diameter to a reduced configuration by winding the shield up on itself to facilitate removal from the surgical site. Alternatively, the shield 200 can be removed by pulling the shield 200 vertically or along the long axis of the shield.

  52-53 show a spiral shield 200 on a core pin of a mold 220 having a helical shape. The shield 200 is molded on a helical mold 220 to produce the spiral shield 200 by injection molding. Once unwound off the core pin of the mold 220, the shield 200 can be made to follow its functional spiral configuration by pushing one end forward or backward of the adjacent winding. Since the shield 200 is initially formed into a spiral and then allowed to follow the spiral, it has a memory of some springback tension inside, trying to take on the spiral instead of remaining in a complete spiral. Tend. If the shield 200 has an undesirable excessive amount of spring bias tension, the annealing process can be performed by placing the shield 200 in an oven at a suitable temperature for an allotted time and then removing it, thereby Residual tension is reduced or reduced. However, in one variation of shield 200, a degree of residual tension is advantageously desirable because the tendency of shield 200 to expand along the longitudinal axis facilitates removal of the device from the incision site. A tab (not shown) may be formed on one end, such as the proximal end, the inner end or the outer end of the shield 200, and / or a hole that may be attached through a drawstring near one end of the shield Can be formed so that the physician can easily pull the strap or tab out of the incision site. The tabs or holes can indicate the preferred preference when inserting the shield, so take advantage of the tension of the helix when removing the device with the tabs / holes proximal to the surgeon outside the patient It can be done. In one variation, the first inner end 202 following the interior of the winding can be provided with tabs or holes for this removal feature. As the inner end 202 is pulled vertically during removal, the coil of the shield's band will gradually unwind and exit the incision.

  As an alternative to injection molding, the spiral shield 200 can be manufactured by die-cutting and thermoforming the plastic sheet stock into a predetermined shape. Also, instead of injection molding the shield 200 in a spiral, the spiral shield 200 can be injection molded directly in a spiral.

  Referring now to FIGS. 71A and 71B, shield 200 is shown in an expanded elongated configuration and a compressed or unexpanded configuration, respectively. The expanded configuration of shield 200 is also illustrated in FIGS. The shield 200 in the expanded configuration can be converted to the compressed configuration by overlaying the inner surface 208 on the outer surface 210. The compressed configuration of shield 200 is also illustrated in FIGS. 76-79. At least a portion of shield 200 overlaps itself in the unexpanded configuration, as is clearly shown in FIGS. 78A-78C. In FIG. 78C, it is shown that one portion of the shield 200 is nested within the concave surface of the outer surface 210 of an adjacent overlapping portion of the shield 200. The shield 200 is adapted to be at least partially rolled or curled around the major axis 218. The shield 200 is adapted to be at least partially rolled or curled onto itself about the major axis 218, with a portion of the shield 200 juxtaposing or contacting other portions of the shield 200. It is designed to overlap or be placed as it is. When in the unexpanded configuration of FIG. 71B, the shield 200 is in addition to a compact configuration in which the unexpanded configuration is rolled into a tight roll with reduced diametrical or lateral dimensions suitable for insertion into a wound or orifice. Have a relaxed or normal lateral configuration. The shield 200 has a bias biased in a relaxed or normal lateral configuration and tends to be biased towards the bias after being inserted into the wound or orifice, the shield 200 As 拡 張 expands from a compact configuration to a larger configuration, depending on the material used for the shield 200 and the force exerted by the surrounding tissue in response to the inserted shield 200, it will exert some retraction force on the tissue. If the wound or orifice is tight, the shield 200 may not expand from its reduced lateral insertion configuration, or slightly unrolls to expand its lateral dimensions slightly as it attempts to become its normal relaxation configuration. In some cases, or the shield 200 may extend its full travel to its normal relief configuration.

  The longitudinally expanded configuration of the shield 200 shown in FIG. 71A is the result of this being molded over the helical mold 220. The shield 200 defines a major axis 218 about which the shield 200 is centered. The shield 200 is made of a material that is at least partially biased towards the longitudinally extended position. The shield 200 can be made of shape memory material or can include parts made of shape memory material. When in the longitudinally compressed configuration, the bias to the longitudinally expanded position does not cause the shield 200 to spring suddenly into the longitudinally expanded configuration. Because the concave surface of the outer surface forms a bottom lip, also referred to as a top lip, also referred to as a top flange 222, and at least a portion of the top flange 222 is in a compressed configuration, adjacent overlapping top flanges 222 And the at least a portion of the bottom flange 224 is adapted to abut the adjacent bottom flange 224 while in the compressed configuration, so that the longitudinally compressed configuration suddenly and easily in the longitudinal direction This is to prevent the extension configuration. At least one of the top flange 222 and the bottom flange 224 serves as a stop that prevents the shield 200 from expanding from the compressed configuration to the expanded configuration. The bias biased into the expanded configuration provides a degree of friction to the device itself, which aids in adjusting the lateral dimension or diametric expansion of the shield 200. When in the compressed configuration, the shield 200 can be rolled / curled around the major axis to reduce the diametrical or lateral dimension, thereby reducing the size of the shield 200 and the diameter of the central lumen 216. Can be made smaller and easier to insert through a small, minimally invasive incision or orifice.

  FIG. 80 shows the shield 200 in a relaxed or normal lateral configuration with a circumferential wrap approximately 1.25 times the circumference, with the central lumen 216 as the shield inner diameter or bore diameter 226. And shield diameter 228 or outer diameter, both of which serve as lateral or diametrical dimensions of the shield 200. FIG. 81 shows a plan view of the shield 200. FIG. In FIG. 81, the shield 200 is in a compact configuration suitable for insertion into an incision / orifice where the shield 200 is rolled on itself into a tighter roll. The shield 200 in FIG. 81 has a circumferential wrap of approximately 2.25 or more times the circumference and has a reduced bore diameter 226 and shield diameter 228 as compared to the relaxed normal configuration of FIG. There is. The overlapping portions of the shield 200 act to hold in contact with one another and hold the reduced lateral dimension position slightly by friction, but the lateral dimension bias has an unstressed or relaxed radial normal configuration. The shield 200 tends to be in a normal configuration. Compact configurations having reduced lateral dimensions are suitably adapted for insertion into a wound or orifice. From the compact configuration, the shield 200 expands from the reduced lateral dimension position towards the normal unstressed lateral dimension configuration when released outside the wound or orifice. This expansion in situ may be limited by the force exerted by the tissue in response to the force exerted by the inserted shield 200. The shield 200 includes a central lumen 216 having a circular shape and diameter, but the invention is not limited thereto, but variations include an elongated lumen 216 such as an oval or oval having a length greater than its width. It has the shield 200 which it has. Therefore, the outer periphery of the shield 200 may or may not have a corresponding shape. In variations where the perimeter of shield 200 has a shape corresponding to the shape of central lumen 216, if lumen 216 is circular, then the perimeter of shield 200 is also circular, or central lumen 216 is oval or oval. If so, the perimeter of the shield also has an oval or oval shape.

  As mentioned above, the shield 200 includes a top flange 222 and a bottom flange 224 as part of the concave outer surface 210 of the shield 200. During the longitudinal unexpanded configuration, the shield 200 is generally symmetrical with respect to a plane perpendicular to the major axis 218, in which case the top flange 222 and the bottom flange 224 are radially outward from the major axis 218 as shown in FIG. Extend at approximately equal distances towards one another. Referring to FIG. 79, a variation of shield 200 in which shield 200 is not symmetrical with respect to a plane perpendicular to longitudinal axis 218 is shown. In FIG. 79, the top flange 222 extends radially outward from the major axis 218 a distance greater than the distance that the bottom flange 224 extends radially outwardly from the major axis 218. The shield 200 thereby forms an enlarged top flange 222 relative to the bottom flange 224. The enlarged upper flange 222 advantageously provides greater protection surface area for the surrounding tissue and / or storage bag, and more for the surgeon to use when morselizing / reducing tissue. Provide a large cutting board surface.

  Referring to FIG. 82, a variation of shield 200 having finger pulls or tabs 230 is shown. Tabs 230 are shown integrally formed at or near the first inner end 202 of the shield 200. A tab 230 extends from the first inner end 202 and from the upper end 212 of the shield 200 and is an extension adapted to be easily grasped by the user with either the user's finger or an instrument such as a grasper. Form In one variation, the tab 230 includes a hole 232 configured to provide a place for insertion of an instrument or finger. In another variation, the holes 232 are not present. The tab 230 is configured to convert the shield 200 from the unexpanded configuration to the expanded configuration when the tab 230 is pulled generally upward or proximally. Applying an upward force to the first end 202 through the tab 230 results in the bottom flange 224 of the first end 202 unhooking or moving from the adjacent lower flange 224 of the shield 200, One end 202 is separated from the nested position of the overlapping curvature of the adjacent shield 200 portion. As the proximal end of the tab 230 is pulled upward, it leads to a longitudinal extension of the shield 200 so that the first inner end 202 comes out of the unexpanded configuration first and the rest of the shield 200 Are guided progressively out of the nested juxtaposition of the unexpanded configuration, resulting in the spiral shape of the shield 200 of the expanded configuration. FIG. 82 shows the shield 200 in an unexpanded configuration and the tabs 230 integrally formed with the shield 200. In another variation, the tab 230 is a separate element attached to the first end 202 of the shield 200 by an adhesive, staples or other fasteners. In yet another variation, the tab 230 includes a tether attached to the shield 200, and in another variation the tab 230 is a tether and not an extension of the shield 200.

  Referring to FIGS. 83-84, a shield 200 having a lock 234 is shown. Lock 234 is configured to lock its lateral or diametrical dimension when shield 200 is in the unexpanded configuration. When the shield 200 is placed in situ, the force of the surrounding tissue may force the lateral or diametrical dimension of the shield 200 to be smaller than desired. The shield 200 can include a relaxed normal configuration while in the unexpanded configuration, but the bias incorporated into the shield 200 may or may not necessarily be sufficient to overcome the forces of the surrounding tissue Even smaller than a surgeon's preference for a particular procedure or for a particular instrument through the central lumen 216 or for a particularly large specimen of target tissue. In any case, the lock 234 is configured to substantially fix, lock and hold the lateral or diametrical dimension of the shield 200, and in particular the lateral or diametrical dimension due to the force from the surrounding tissue. Prevent shrinkage. For example, when the shield 200 is inserted into an incision or orifice that is relatively smaller than the lateral dimension of the shield 200, it is initially reduced to a compact configuration as shown in FIG. While in the compact configuration, the shield 200 is inserted into the wound or orifice. The force of the surrounding tissue in response to the inserted shield 200 may be greater than the bias that biases the shield 200 back to the unstressed relaxed normal configuration. In such cases, the surgeon may desire the larger central lumen 216 relative to the shield 200 or may want to retract the surrounding tissue. The surgeon now unrolls shield 200 into a larger lateral or larger diametrical configuration and locks its position with lock 234 provided on shield 200. In one variation, the lock 234 includes a first notch 236 located at a distance proximal to the first end 202 of the shield 200 and near the top end 212 and a second outer end 204 of the shield 200. And a second notch 238 located at a distance near the proximal end 212. The notches 236, 238 are located proximal where one end 202 of the shield 200 overlaps the other end 204 of the shield 200 in the unexpanded configuration. The shield 200 is shown in the unlocked configuration in FIG. To lock the shield 200, the shield 200 is expanded in lateral dimension by unrolling the shield 200 to form a larger central lumen 216. The first notch 236 overlaps the second notch 238 to lock the shield 200 in a fixed diametrical / radial position, and the remaining portion of the shield 200 is circumferentially around the periphery of the shield 200 Maintain some overlap. FIG. 84 shows the first notch 236 overlapping or interlocking with the second notch 238 in a locking configuration. During the locking configuration, at least a portion of the first end 202 is located outside at least a portion of the second end 204 and a portion of the inner surface 208 of the first notch 236 is a second It is adapted to face the outer surface 210 of the notch 238. In order to unlock the shield 200, the notches 236, 238 are unhooked from one another.

  As mentioned above, the shield 200 can be inserted into the wound or orifice by winding and / or crushing it to a smaller diameter and then inserting it into the wound or shield. Insertion of the shield 200 can be facilitated with common surgical instruments such as clamps or graspers. Once inserted, the shield 200 naturally opens slightly and the tissue surrenders out of its form. In one variation, the shield includes a lock 234 that allows the shield 200 to lock to a diameter slightly larger than the diameter that it naturally blocks. The lock 234 includes notches 236, 238 along the outer edge of the shield 200 near the first and second ends 202, 204 where the spiraling material overlaps. The notches 236, 238 overlap when in the locking configuration such that at least a portion of the inner end of the shield 200 snaps so that it is outside the outer end of the shield 200. The exposed tabs of the lock 234 can be pinched into an overlapping state to provide a mechanical interlock point.

  Referring now to FIGS. 85-86, another variation of the lock 234 on the shield 200 is shown. Lock 234 includes interlocking teeth. Specifically, the first set of outer teeth 240 is formed on the outer surface 210 near the first inner end 202 of the shield 200, and the second set of inner teeth 242 is the second of the shield 200. Is formed on the inner surface 208 near the outer end 204 of the The first set of outer teeth 240 is located within the concave surface near the first inner end 202 and extends substantially longitudinally. The second set of inner teeth 242 is located within the convex surface near the second outer end 204 and extends substantially longitudinally. The outer teeth 240 and the inner teeth 242 can also be angled. In one variation, the teeth 240, 242 are angled so that they can slide or tilt more easily when moving from a reduced lateral dimension to an increased lateral dimension. The angles of the teeth lock the ends together and prevent the shield 200 from collapsing laterally at the wound or orifice due to the force of the tissue. The outer teeth 240 and the inner teeth 242 are configured to interlock with one another to prevent reduction in the lateral dimension of the shield 200. Because the plurality of inner teeth 240 and the plurality of outer teeth 242 are formed along at least a portion of the outer periphery near the first and second ends 202, 204, the position at which the shield 200 is locked is It can be adjusted as required, so that the lateral dimensions can be fixed as desired. Although the teeth 240, 242 are shown as being located midline perpendicular to the major axis 218, the present invention can include teeth provided at any location along the longitudinal dimension.

  In another variation of the lock on the shield 200, the shield 200 can be provided with a protuberance extending from the inner surface. The ridges can be shaped like hooks and can be configured to engage with notches or openings formed in adjacent portions of the shield 200. In one variation, the ridge is near one of the first inner end 202 and the second outer end 204, and the notch or opening is the first inner end 202 and the second outer. It is formed near the other of the end 204.

  The shield 200 guards the tissue around a wound or orifice in the body during surgery from a sharp object such as a blade or morcellator. The terms wound, orifice, incision, body opening are used interchangeably herein. The wound is generally a minimally invasive incision that penetrates the abdominal wall for laparoscopic or other types of surgery. The shield 200 is a spiral spring in an expanded configuration that includes a ribbon of spirally formed material that generates an outward force when inserted into a wound or orifice. The shield 200 also retracts the tissue in the wound or orifice to traverse the abdominal wall or an opening through the orifice via the central lumen 216, which is generally circular when viewed along the long axis 218. provide. In one variation of the shield 200, the shield 200 is made by winding a ribbon of non-curved but substantially flat sheet material into a cylindrical or conical form. In another variation, the curved ribbon shield 200 has a C-shaped longitudinal cross-section when viewed from the side. The proximal and distal edges, also referred to as the superior end 212 and the inferior end 214, are larger in diameter than the middle portion of the shield 200 to form an upper flange 222 and a lower flange 224, respectively. This C-shaped configuration advantageously cups the tissue at the wound opening to provide an anchor-like anchor, so that the shield 200 easily disengages axially from the wound or orifice during normal use Absent. In one variation, the C-shape is parabolic as shown in FIG. The apex of the parabola lies in a plane perpendicular to the major axis 218. In another variation, the apex is located between the top end 212 or bottom end 214 and the longitudinal midline.

  Removing the shield 200 from the wound or orifice first disengages any interlocking features 234 and then grasps the exposed inner corner of the shield 200 and curls it inwardly in the direction of the material's spiral. It is then accomplished by pulling it up along the longitudinal axis out of the wound or orifice. The shield 200 advantageously pivots out like a corkscrew out into a helical form in the expanded configuration. The shield 200 can be withdrawn manually with the aid of a finger or with the aid of a common surgical instrument such as a clamp or grasper. One variation of the shield 200 is made of a cut resistant but flexible plastic material. The choice of material and thickness provide the feature of protection. The shield 200 is sufficiently flexible for insertion and removal, but sufficiently rigid to provide protection while remaining fixed.

  The shield 200 provides several advantageous features. One important feature provided by the shield 200 is to protect surrounding tissue from sharp objects such as blades, scalpels and morserators. The shield 200 also provides protection to the storage bag in which the shield is placed, thereby protecting the storage bag from piercing or cutting by sharp objects and storing biological specimens with a reduced risk of leakage. To ensure that is maintained. The upper flange 222 provides broad base or cutting board like protection to the tissue and bag surface around the wound or orifice. The upper flange 222 overlaps, covers and protects the tissue edge and / or the storage bag. The middle portion of the shield 200 also shields the tissue at the wound or orifice and also protects the storage bag in which the shield is located if a storage bag is used. More preferably, the middle part is reached by the surgeon deeply with the blade, and the tissue specimen is cut closely in or above the midline horizontal to the longitudinal axis, and the shield 200 The distal end is allowed to reach beyond the midline plane of to allow cutting of the tissue specimen, since the entire longitudinal length of the shield 200 provides protection to the surrounding tissue and the storage bag.

  Another advantage of the shield 200 is that it includes a mooring feature. The shield 200 is advantageously configured to anchor itself within the wound and orifice by a C-shaped design. The anchoring feature dramatically facilitates and accelerates the molaring procedure because it does not require a suture or other hand to hold the shield 200 in place during normal procedures. Double flanges (top and bottom 222, 224) are provided to capture the tissue or abdominal wall within the C-shaped concave and to anchor the shield 200. The shield has a distal anchoring member for internal position within the wound and a proximal anchoring member for external position of the wound opening. Single flanges, either top or bottom, are also within the scope of the present invention. Further, although top flange 222 and bottom flange 224 are shown extending around the full circumference of top end 212 and bottom end 214, respectively, the invention is not so limited and top and bottom flange 222, Any one or more of 224 may extend around at least a portion of the circumference. In such variations, finger-like extensions can be formed instead of the circumferential bottom flange 224. The fingers can be easily bent along the longitudinal direction to facilitate insertion and then spring loaded into the radially outwardly anchored position beneath the abdominal wall or other tissue or orifice. Also, the top flange 222 can extend a longer distance radially outward than the bottom flange 224 as shown in FIG. 79, and vice versa, to provide a larger cutting board-like surface.

  Furthermore, the shield 200 is advantageously adapted for easy insertion and removal to the wound or orifice. The shield 200 includes a longitudinally expanded configuration and a longitudinally unexpanded configuration to provide the shield 200 with longitudinal variability. This allows shield 200 to be easily removed simply by pulling proximally one end of shield 200, and shield 200 unhooks from adjacent overlapping flanges and / or concaves, corkscrewed It pivots from the nested unexpanded configuration into an expanded spiral shape. Tabs, holes, and / or tethers 230 are provided to assist in gripping and pulling the shield 200 in the longitudinal direction. Further, while in the nested or unexpanded configuration, shield 200 is movable, rolling or curling shield 200 on its own to form smaller or tighter circles and more rotation about itself. The compact configuration is achieved. The shield 200 advantageously moves from the laterally compact configuration by releasing the compact configuration, thereby presenting a normal relief configuration having a relatively large lateral dimension. A larger configuration is also provided by the shield 200, where the lateral or diametrical position, which is larger than the normal or relaxed configuration, can be locked in place by the lock 234 formed in the shield 200. The lateral variability of the shield 200 allows the lateral dimensions to be reduced to facilitate insertion into the wound site or orifice. Also, from a locked, diametrically increased position, the shield 200 simply unlocks the shield and / or unlocks the shield and then curls the shield on itself into a tighter configuration By this, it can be unlocked and the size of the lateral dimension can be reduced, which facilitates the removal from the wound or the orifice.

  The shield 200 is advantageously self-deploying. After curling the shield 200 into a compact lateral configuration, the shield 200 tends to increase in size due to its spring bias when it is easily inserted into the wound or orifice and then released. This springback action in the lateral direction helps to automatically seat the shield 200 in the wound or orifice with little effort, while providing protection and retention for the tissue and / or storage bag, both Hold out of the path of sharp objects that can be encountered during normal procedures.

  Furthermore, while in the longitudinal unexpanded configuration, the shield 200 has a generally C-shaped or hourglass-shaped profile, where the proximal end flares radially outward from the major axis, The proximal end flares radially outward from the long axis, and the torso is the narrowest lateral dimension along the plane between the proximal and distal ends of the shield. The flare at the distal end of shield 200 advantageously provides an angled surface or funnel to guide and move the target tissue into and through shield 200.

  The flexibility of shield 200 allows it to be superior in insertion, deployment, removal, and in anchoring due to expansion. The flexibility is advantageously balanced against the surrounding tissue and / or its ability to provide protection for the storage bag. The protection provided by the shield 200 is sufficient for manual molseration procedures when properly performed, while at the same time giving the surgeon the freedom to use a personal molseration procedure. The shield 200 may be inserted into the mouth of the storage bag and positioned within the neck of the storage bag or within the main receptacle of the storage bag. A storage bag surrounds the shield 200 and is captured between the tissue / orifice and the shield 200. The shield 200 serves to retract the surrounding tissue as well as the surrounding storage bag material. The shield 200 exerts a sufficient force on the storage bag so that the storage bag is substantially fixed and held in place and does not slip into the wound or orifice. A sufficient amount of the proximal end of the bag is located proximal to the shield and overlies the outer surface, such as the patient's abdomen, to form a blanket that helps prevent contamination. The shield 200 is configured to hold the mouth of the storage bag in an accessible open configuration to receive and support a manual or powered molcerator device.

  In another variation, the shield 200 is adapted for insertion into the vaginal canal and is therefore longer than shown. The shield 200 can also include shape memory components to assist in deployment. The shield 200 provides reliable and safe removal of endogenous samples, is easy to use and reduces surgery time and cost. The shield 200, in combination with the storage bag, helps to reduce the risk of healthy tissue being contaminated by potentially malignant cells during tissue sampling.

  With reference to FIGS. 54-59, a bag 310 according to the present invention will now be described. The bag 310 includes a single opening or mouth 312. A semi-rigid compressible plastic ring 314 is connected within the bag 310 at or near the mouth 312 of the bag. The ring 314 can be compressed from a circular or large configuration to an oval or smaller configuration so that the bag 310 can be inserted through the small incision. Once inside the patient, the resilient ring 314 expands to the original, uncompressed, larger configuration, opening the mouth 312 of the bag 310 therewith. When placed flat inside the patient, the ring 314 clearly defines the opening 312 of the bag 310 which may be difficult to see under laparoscopic observation if the ring 314 is not present. Sometimes the opening 312 of the bag 310 may be difficult to find. In that case, the opening 312 has to be oriented inside the patient so that the tissue is clearly disposed therein and not past the opening 312. In the present invention, when the expanded ring 314 is placed on top of the bag 310, any tissue placed in the ring 314 will eventually raise the bag 314 as it is lifted towards the incision. Ensure that it is inside 310. The empty bag 310 lays flat on a flat surface, and the ring 314 naturally falls on the bag 310. The elastic ring 314 allows the bag 310 to remain unassisted open inside the abdominal cavity to facilitate tissue capture.

  After placing the tissue sample inside the ring 314, the ring 314 is pulled towards the incision. A tether 316 is provided near the mouth 312 of the bag 310 to assist the surgeon in pulling the bag 310 towards the incision. The tether 316 can have a tag 318 at its proximal end, which is held outside the patient when the bag 310 is placed inside the patient. The tag 318 is also easy to find inside the patient. The large tag 318 helps to quickly locate and pull the tether 16 as needed. The tether 316 may also be configured to tighten and close the bag 310 to prevent spilling of the contents of the bag 310. Alternatively, there may be additional straps connected to the bag 310 and located above or below the ring 314 to circumferentially close the bag. Other methods such as press fit or zippers for closure or sealing may also be provided.

  When the bag 310 is pulled close to the incision, the ring 314 is compressed from its expanded configuration to its compressed configuration so that it can be withdrawn through the small incision. Ring 314 is compressed by grasper or hand through the opening of the incision. After pulling the ring 314 through the incision, a sufficient amount of the bag 310 is withdrawn with it and placed on a portion of the patient's abdomen to cover it. Therefore, the bag 310 must be quite large to create an apron effect around the external incision of the patient. With the ring 314 and a portion of the bag 310 external to the patient, the remainder of the bag 310 and the tissue specimen remain inside the patient.

  The cross section of the ring 314 can be circular and can have a hollow center to provide flexibility. In one variation, the ring 314 has an oval, elongated or oblong cross section. In the variation shown in the drawings, the ring 314 has a shape similar to the numeral 8, i.e. two connected circular cross-sections, with a small valley 320 between the circles. In general, the cross section of ring 314 has a length that exceeds its width. This elongated cross section allows the bag 310 to be rolled up on the ring 314 itself, rolling or flipping the ring 314 on itself by inverting the ring 314 outwards or inwards. The ring 310 can be rolled in the reverse direction to deploy the bag 310 from the ring 314. The elongated cross section of the ring 314 advantageously keeps the side walls of the bag 310 rolled up on the ring 314. If the cross-section is circular, then the ring 314 may roll more easily, thereby unrolling the rolled up side walls of the bag 310. Rolling the ring 314 around itself pulls the bag 310 upwards bringing the specimen inside the bag 310 near the opening of the incision. The rolling action of the bag 310 reduces the volume of the bag 310 located inside the patient and also forms a well formed pin and taut apron outside the patient. If the retraction of the bag 310 is too tight, the ring 314 may become distorted. The tissue sample is then drawn out of the bag 310 by size and shape so that the tissue sample can be molared with a blade or motorized morsel and can be removed from the bag 310 through a small incision. As shown in FIG. 59, the side walls 328 of the bag 310 can be rolled up on their own to form a roll 330 located adjacent to the ring 314 to facilitate deployment. To facilitate insertion, the ring 314 is crushed so that the compressed length of the ring 314 is aligned with the length of the roll 330.

  With particular reference to FIGS. 55-56, the ring 314 is formed from a single elongated plastic piece 322 and is formed into a circular or other shape by joining the free ends together. In another variation, the ring 314 is made of two or more pieces, such as two semi-circles, which together define a circle of the same radius. The ends are not connected but are held in a normally curved configuration inside the sleeve at the mouth of the bag 310. Multi-piece ring 314 makes it easier to compress ring 314 into a smaller configuration. Ring 314 is approximately 0.38 inches high and 0.18 wide, and approximately 38 inches long. The thickness of the material forming the ring 314 is approximately 0.18 inches.

With particular reference to FIGS. 57-59, the bag 310 is formed from a single sheet 324 of material. The sheet of material 324 is longitudinally folded and the sides heat sealed to form a seam 326. The weakest part of any bag 310 is the area around the welded seam 326. As can be seen from FIG. 57, there is no weld seam 326 at the bottom of the bag 310 where the forces are most concentrated when removing the specimen, which causes the bag 310 to have a stronger limit strength. Also, the material of the bag 310 is made of 4.2 mil Inzii® film, which is transparent, allowing the surgeon to view through the side of the bag 310 during surgery. The visibility through the bag 310 eliminates the need to puncture the side of the bag 310 to achieve visualization. The film is elastic and gives the bag 310 a good retraction. The bag 310 can also be made with a U-5746 ripstop nylon with a polyurethane coating. The polyurethane coating makes the film air tight and heat sealable. U-5746 is a military grade material, stronger than Inzii® film, but less receding and opaque. The bag 310 is approximately 16 inches long and 12 inches wide at the mouth 312, and the bottom of the bag 310 forms an angle of approximately 45 degrees with the side wall 328 at a distance of approximately 12.4 inches from the mouth 312. The bag 310 has a thickness of approximately 0.2 inches, and at the seam 326, the bag 310 is approximately twice as thick. In another variation, the bag 310 is a double bag in which one bag is located in another bag, resulting in greater resistance to accidental puncture. In another variation, the bottom portion of the bag 310 is reinforced with a double wall structure. The bag 310 is leakproof and prevents virus entry.

  As mentioned above, a shield can be prepared and used in combination with the bag 310. The shield is inserted into the mouth 312 of the storage bag 310 after placing the bag 310 inside the patient and pulling it through the incision. The shield is made of thicker plastic to prevent the plastic bag 310 from being inadvertently cut with a blade that the surgeon uses to morselize the target tissue. The shield also acts as a cutting board, allowing the surgeon to cut the target tissue on an as needed basis. The bag 310 can also be used with a retractor as described above, in which case the retractor is placed inside the mouth 312 of the bag 310 when pulling the bag 310 through the incision, and The bag 310 is placed inside the retractor to retract the shield before removing the specimen.

  Referring to FIGS. 60-63, a bag introducer or fork 410 is used to introduce the storage bag 310 through a small incision into a patient's body cavity. The introducer 410 facilitates placing the bag 310 in the surgical field. The fork 410 has a proximal end 412 and a distal end 414. A handle 416 is provided at the proximal end 412. A first prong 418 and a second prong 420 extend distally from the handle 416 to form a generally fork-like configuration. The prongs 418, 420 are of equal length. The prongs 418, 420 can have any suitable cross-section and are separated by a sufficient distance from one another. The prongs 418, 420 are made of stainless steel and are connected to an injection molded plastic or metal handle 416 as shown in FIG. In this design, a steel rod containing prongs 418, 420 is inserted into and connected to the injection molded handle 416, which allows the fork 410 to have a small profile, but the manufacture is more expensive, It takes a long time. In FIG. 61, fork 410 is made from a single piece of material, and both handle 416 and prongs 418, 420 are injection molded to form a unitary structure. This design is the easiest and cheapest to manufacture, but instead results in larger profiles and weaker designs.

  In use, and with particular reference to FIGS. 62-63, the bottom of the storage bag 310 is disposed between the prongs 418 and 420 and the tether 316 and tag 318 are disposed near the handle 416. The bottom edge of the bag 310 is folded over the prongs 418, 420, which extend slightly beyond the end of the bag 310. Thus, the prongs 418, 420 are slightly longer than the width of the bag 310. The handle 416 is grasped and rotated to evenly roll up the bag 310 into a tubular roll 330 until resistance is met. The bag 310 is reduced to a minimal size for introduction into the intangible area. Crush elastic ring 314 and roll up bag 310 until it is taut and next to ring 314. Visually, the combination of bag 310 and fork 410 is inserted through the incision to ensure that opening 312 of ring 314 is positioned upward. The bag 310 is inserted until approximately three quarters of it is in the incision. Rotate the fork 410 in the opposite direction to loosen the bag 310 slightly. Loosening the bag 410 to reduce tension in the bag makes it easier for tissue to fall into the bag 310. The fork 410 allows the bag 310 to be easily deployed while controlling the tightness of the bag 310 and the direction of the ring opening 312. If the bag 310 is rolled too tightly, tissue will not easily fall into the bag 310 when the ring 310 is lifted inside the patient. Rotating the introducer 410 in the opposite direction prior to removing the introducer 410 facilitates easy tissue insertion into the bag 310.

  The fork 410 is separated from the bag 310 by pulling the handle 416 proximally. The remaining quarter section of the bag 310 is pushed into the incision. After the bag 310 is fully deployed in the abdominal cavity, the access port and scope are placed and the cavity is insufflated. The bag 310 is positioned such that the ring 314 rests on top of the bag 310. The access port can be located in the same incision or in the secondary incision. Under eyesight, the tissue to be morsulated and removed from the patient is placed in the bag 310. The side access port can be used to visualize and confirm that the tissue is inside the bag 310. The access port is removed and patient removal of the bag 310 is initiated. The secondary access port does not necessarily have to be removed and can be used to continue the removal and subsequent observation of molars. The tag 318 may be external to the patient. This is pulled to pull the bag 310 towards the incision. When the tag 318 is in the cavity, visualization and grasper through the access port can be used to grip the tag 318. The tether 316 and tag 318 are pulled through the incision until the ring 314 passes through the incision. The ring 314 is pulled until the entire ring 314 is out of the incision. The bag 310 is retracted by rolling / fliping the ring 314 onto itself to roll the bag 310 around the ring 314. Rolling this ring 314 not only slightly retracts the tissue, but also reduces the volume of the bag 310 inside the patient, drawing the tissue inside the patient closer to the surface. The tissue is then molared.

  Alternatively, a retractor with a central lumen is placed at the incision inside the mouth of the bag 310, and the tissue is retracted with the bag 310 to enlarge the opening, and then the bag is used to molese the tissue. Do. A retractor with a central lumen is placed inside the mouth of the bag 310 at the location of the incision and a shield as described above is prepared and used in combination with the bag 310 and the retractor. The shield is disposed within the central lumen of the retractor. Of course, the shield can be used without a retractor. If a retractor is not used, the shield is placed in the mouth 312 of the bag 310 at the incision. The shield is inserted into the mouth 312 of the storage bag 310 after the bag 310 is placed inside the patient and pulled through the incision. The shield is made of a thicker plastic to prevent the plastic bag 310 from being inadvertently cut with a blade or other device that the surgeon uses to morselize the target tissue. The shield also acts as a cutting board, allowing the surgeon to cut the target tissue on demand as needed. The shield itself can also function as a retractor having a first reduced size and a second expanded size. The second expanded dimension serves to retract tissue.

  If a retractor is used inside the bag 310, the retractor advantageously not only retracts the tissue but also retracts a portion of the bag to keep the bag out of the path of the morselation blade, thereby cutting the bag And protect from puncture. A typical retractor includes top and bottom rings and flexible side walls connecting them. The bottom ring is inserted through the incision and is inside the patient, while the top ring of the retractor is above the patient. The upper ring is rolled / flip on itself as well as the bag, pulling the lower ring of the retractor closer and bringing the side walls into a taut relationship between the rings. The lower ring of the retractor advantageously retracts a portion of the bag 310 inside the patient away from potential damage that may be caused by puncturing and tearing from the blade.

  The tissue is molarated in the manner desired by the surgeon. Generally, a small portion of the target tissue is withdrawn outside the patient while a larger portion of the target tissue remains inside the patient. The surgeon uses a blade to make a circumferential cut of approximately 180 degrees or 360 degrees around the circumference of the protruding tissue without separating the protruding tissue from the rest of the target tissue. Keeping the protruding tissue intact with the larger pieces inside the patient allows the surgeon to keep gripping the tissue without losing sight inside the bag. Since the surgeon withdraws the grasped tissue little by little from the patient, periodically making circumferential cuts of any size, more tissue can be withdrawn until the entire piece of target tissue is removed. The result is a single elongated piece of target tissue that is removed instead of multiple smaller pieces. Even if not removed in one piece, target tissue is removed in fewer pieces and in a more controlled manner. The bag 310 can be further retracted during molseration to bring the analyte closer to the surface. Once the tissue remaining in the bag 310 is small enough to easily pass through the incision, the bag 310 is completely removed.

  64-65, another shield 510 according to the present invention is shown. Shield 510 comprises a first ring 512 at proximal end 514 and a second ring 516 at distal end 518. The rings 512, 516 are substantially parallel to one another and are interconnected by side walls 520. Sidewall 520 is a textile sheath material, which can be made of a flexible textile or polymer. The material can be Kevlar (R), Dyneema (R), ripstop nylon, or a polymer blend material. Sidewall 520 is heat sealed or bonded to rings 512, 516. The first and second rings 512, 516 are semi-rigid and compressible between a normal high profile large configuration and a compressed low profile elongate configuration. The rings 512, 516 are generally circular in their normal configuration or can be oval. Since the rings 512, 516 can be compressed from a circular or large configuration to an oval or smaller configuration, the shield 510 protects it in the small incision, in particular in the mouth of the storage bag It can be inserted into the In one variation, only the second ring 516 is compressible for insertion into the incision, with the first ring 51 intended to stay proximal to or external to the patient. , The first ring 512 is rigid. The rigid proximal first ring 512 can be made wider and wider to act as a larger shield or cutting board for molseration. The second or distally disposed ring 516 is flexible for compression and easy insertion into the bag, and may be slightly smaller in diameter than the first ring 512.

  The cross section of one or more of the rings 512, 516 can be circular. Rings 512, 516 have a hollow center to provide flexibility. In one variation, the rings 512, 516 have an oval, elongated or oval shape with a hollow center. In another variation, rings 512, 516 have two connected circular cross sections, similar to the numeral 8 as shown in FIGS. 55A-55B, with a small valley formed between the circles. Have. In general, the cross section of the rings 512, 516 has a length that exceeds its width. This elongated cross-section rolls or flips the rings 512, 516 onto itself by inverting the rings 512, 516 outwards or inwards, rolling up the sidewall 520 onto the rings 512, 516 itself Make it possible. In one variation, only the first ring or proximal ring 512 is configured to roll up the sidewall 520. In another variation, both rings 512, 516 are configured to roll so that the shield 510 is bi-directional, ie, either the first ring 512 or the second ring 516 to the incision / orifice It can be positioned proximal to and rolled. The shield 510 is inserted by compressing one or more of the rings 512, 516. Both rings 512, 516 can be compressed into a low profile configuration for easy insertion through the incision, but generally only the distal ring needs to be compressed and is external to the patient The proximal ring does not necessarily have to be compressed. Also, since the distal ring is internal to the patient, only the proximal ring needs to be configured to roll the sidewall 520. The one or more rings 512, 516 configured to roll can be rolled in the opposite direction to increase the length of the sidewall 520. When one of the rings 512, 516 is rolled, the length of the sidewall 520 is wound onto the ring, shortening the length of the shield 510. The elongated cross section of the ring advantageously keeps the side walls 520 rolled up on the ring. If the cross-section is circular, the ring may roll more easily in situ, which will cause the rolled up sidewall 520 to unwind. Rolling the ring around itself pulls the opposite ring upwards and closer.

  The rings 512, 516 are formed from a single elongated plastic piece and are formed in a circular or other shape by joining the free ends together. In another variation, the rings 512, 516 are made of two or more pieces, such as two semi-circles, which together define a circle of the same radius. The ends are not connected but are held in a normal curved configuration. Multi-piece rings make it easier to compress the rings into smaller configurations. The ring is approximately 0.38 inches high and 0.18 wide, and approximately 38 inches long. The thickness of the material forming the ring 314 is approximately 0.18 inches. FIG. 65 places the shield 510 inside the bag 310 and retracts the proximally located first ring 512 by rolling until the proximal rigid ring 512 is flush with the outer surface of the patient's abdomen Indicates that. The cut resistant material of the rings 512, 516 as well as the side wall 520 protects the bag 310. Retraction by rolling the proximal first ring 512 advantageously stretches the incision. The resulting larger incision allows for easier manual molaration. In another variation, the shield 510 is not configured to allow rolling one or more of the rings 512, 516 to reduce the length of the shield 510; The side walls are made of protective material.

  66-67, another shield 510 according to the present invention is shown. The shield of FIGS. 64-65 in that this shield 510 comprises a first ring 512 at a proximal end 514 interconnected by a flexible sidewall 520 and a second ring 516 at a distal end 518. Similar to. The sidewall 520 of the variation shown in FIGS. 66-67 comprises a first layer 522 and a second layer 524 which are shown separately and laid flat in FIG. The first layer 522 includes a plurality of longitudinal slits 526 and the second layer 524 includes a plurality of longitudinal slits 528. The first layer 522 is disposed adjacent to or in juxtaposition to the second layer 524 to form a lanthanum-like sidewall 520, and the slits 526 of the first layer 522 and the slits 528 of the second layer 524 are Because they are offset, the slits do not meet to create a tear through the shield 510. Instead, the overlapping layers 522, 524, together with their offset slits 526, 2528, form a flexible but strong, penetration resistant sidewall 520. Each of the first layer 522 and the second layer 524 is a flexible or semi-flexible sheath that is easily bent but cut resistant. Layers 522, 524 are sufficiently flexible to facilitate insertion but still involve flipping rings 512, 516 as described above when placed inside the bag in the incision. Retraction is possible, with or without. In another variation, the slits 526, 528 are not perpendicular to the top and bottom edges of the layers 522, 524 as shown in FIG. Instead, the slits 526, 528 are angled with respect to the top and bottom edges. The overall height of the shield 510 is approximately 0.5 to 2.0 inches, and the sidewall 520 is made of a protective material.

  Referring now to FIGS. 68-70, another variation of a shield 530 in accordance with the present invention is shown. The shield 530 is made of a flexible or semi-rigid plastic. The shield 530 includes a flange 532 that is substantially planar and includes an opening 534 in the middle. From the opening 534, a plurality of slits 536 extend outwardly from the circumference of the opening 534 into the flange 532 to increase the flexibility of the corner intersection. The flange 532 is sized and configured to fit inside the retractor when it is used. Specifically, the flange 532 is snapped under the upper ring of the retractor to help hold the shield 530 in place.

  The flange 532 is connected to the central pipe section 538. The tube section 538 includes a central lumen extending between the proximal opening 534 and the opening 540 at the distal end. The tube section 538 can also include a plurality of slits 542 extending upwardly from the distal opening 540. The shield 530 further includes two fingers, or extensions 544, which extend downwardly from the tube section 538 at an oblique angle defining a first configuration of the fingers 544. The fingers 544 include a second configuration, which is a reduced or compressed configuration as shown in FIG. 69, where the fingers 544 are pushed or folded together towards the long axis, transverse to the central tube section 538 It has a lateral dimension equal to or less than the directional dimension. The reduced configuration facilitates insertion of the shield 530 into the incision or orifice. When inserted through the abdominal wall as shown in FIG. 70, the fingers 544 are advantageously configured to spring back to a first configuration in which the fingers 544 flare outward at an angle. In this first configuration, inside the incision, the fingers 544 advantageously retract not only tissue but also the bag (not shown) into which it is inserted. The slit 542 provides additional flexibility at the distal end of the central portion 538, which exhibits a narrower configuration when placed within the incision, and then snaps to its normal configuration to assist in retraction of the bag and tissue. Make it possible to back. The height of the flange 532 and central portion 538 is approximately 0.5 to 2.0 inches, and the shield 530 is made of HDPE, LDPE, HYTREL®, or other suitable polymer or metal. The shield 530 can also include more than two fingers 544.

  Referring now to FIGS. 87-90, a molaration system 600 is shown. The morcellation system 600 is a device that allows for the bulk removal of body tissue or organs through a limited surgical opening in a safe manner. The molaration system 600 is a substantially closed system that prevents contamination of surrounding tissue by potential cancer cells that may be present in the target tissue during the molaration and extraction procedures. The molaration system 600 includes a molarator 602, a storage bag (not shown), a support rod 606 and a shield 608.

  The storage bag may be any of the bag embodiments described herein. In general, the storage bag comprises a polymeric pouch having a mouth or opening attached to the ring, the ring surrounding the opening of the mouth. The ring is flexible and configured to be biased in an open configuration such that the mouth of the bag is kept open by the ring to facilitate insertion of the sample into the bag . The ring is flexible so that it can be compressed to a low profile, thereby making it easily insertable into the wound or orifice. The ring maintains the opening and also allows the bag to be retracted by rolling the ring around itself and winding the side wall of the bag around the ring. Attach a tether to the proximal end of the ring or bag. The tether includes an attachment tag for grasping with a surgical instrument.

  Morcellation system 600 further includes a morcellator 602. The molserator 602 is a power molserator. The morcellator 602 includes a cutting ring or annular blade 610 having a sharp distal end adapted to cut tissue. The annular blade 610 is mounted to the hollow cylinder 612. The cylinder 612 is connected via gears to a pneumatic or electric motor (not shown) and is configured to rotate about its longitudinal axis. The molserator 602 includes an inner cylinder 614 having a flared or funnel-like proximal end connected to the molserator housing 616. The distal end 620 of the inner cylinder 614 extends to a proximal position of the annular blade 610. Inner cylinder 614 defines a working channel or central lumen 618 of morcellator 602. The inner cylinder 614 prevents tissue drawn into the central lumen 618 from spilling into the morcellator 602. Morcellator 602 further includes an outer cylinder 622. Outer cylinder 622 coaxially surrounds cutting cylinder 612. The outer cylinder 622 has a proximal end connected to or forming a portion of the housing 616. The distal end 624 of the outer cylinder extends to a proximal position of the distal end of the blade 610. Outer cylinder 622 includes an extension 626 at distal end 624 of outer cylinder 622. The extension 626 extends slightly beyond the distal end of the blade 610. The extension 626 prevents coring of the sample to be morsulated.

  The molaration system 600 further includes a shield 608. The shield 608 may be any of the shields 608 described herein, and in one variation, as described with respect to FIGS. 51-53 and 71-86. The shield 608 has a generally spiral shape when in the longitudinally expanded configuration. The shield 608 can be crushed into a low profile, unexpanded configuration. The shield 608 can be moved repeatedly from expanded to unexpanded configurations, and vice versa, as needed. The shield 608 is a flexible plastic band having the form of a spiral in the expanded configuration. The shield 608 can also be made of a thin flexible metal or other suitable material that prevents sharps from penetrating the shield 608. The band extends between the first and second ends and between the top or proximal end 628 and the bottom or distal end 630. The distance between the proximal end 628 and the distal end 630 is approximately the entire length 638 of the shield 608 between the unexpanded or low profile configuration. The shield 608 has an inner surface 632 and an outer surface 634 interconnected by the proximal end 628 and the distal end 634 and by the first and second ends. The outer surface 634 is concave and the inner surface 632 forms a convex tracking surface as viewed from within the shield 608. The outer surface 634 is substantially parallel to the inner surface 632. The shield 608 defines a central lumen 636. When in the low profile, unexpanded configuration, the shield 608 can be reduced in size in the lateral direction to have relatively small lateral dimensions. As mentioned above, the shield 608 includes a relaxed normal position having a first lateral or diametrical dimension during the low profile unexpanded configuration. The shield 608 also includes a reduced configuration having a second lateral or diametrical dimension during the low profile unexpanded configuration. The second lateral or diametrical dimension is smaller than the first lateral or diametrical dimension. The reduced configuration when in the unexpanded configuration is achieved by curling the shield 608 on itself into a tighter, smaller configuration. The curling action reduces the size of the central lumen 636. This reduced configuration can be held fixed by hand or by a lock. Inserting the shield 608 into a small incision or orifice is greatly facilitated by curling the shield 608 on itself into a contracted configuration. When inserted into the incision or orifice, the shield 608 is then released, allowing the tight curl to unroll and to a relaxed normal position with a larger lateral dimension. However, forces from the surrounding tissue may prevent the shield 608 from reaching the first lateral or diametrical dimension, thus the shield 608 may have a second lateral dimension equal to or greater than the first lateral dimension. It may reach a dimension equal to the directional dimension or may have a dimension somewhere between the first transverse dimension and the second transverse dimension. Additionally, shield 608 can be anchored to an expanded configuration with a third lateral or diametrical dimension. The third lateral or diametrical dimension is greater than the first lateral or diametrical dimension. The expanded configuration can be locked in place on the shield 608 by any of the locks described herein that fix the position and lateral or diametrical dimension of the shield 608. This expanded configuration can serve to retract tissue and expand the orifice or wound opening. The reduced configuration and the relaxed normal configuration, and any position from the reduced configuration to the expanded configuration, can serve to retract tissue and hold the wound and orifice open while passing through the central lumen 636 Provide a working channel

  With particular reference to FIGS. 87 and 88, the morcerator 602 is shown inserted into the central lumen 636 of the shield 608. The distal end of morcellator housing 616 abuts the proximal end 628 of shield 608. The length 640 of the morcellator 602, including the blade cylinder 612, the inner cylinder 614 and the outer cylinder 622, extending downwardly from the housing 616 is approximately equal to the length 638 of the shield 608. In one variation, the length 638 of the shield 608 is shorter than the extension 626 protruding from the outer cylinder 622. FIG. 87 shows an extension 626 extending beyond the length of the shield 608. In such variations, the distal end of the shield 608 is just proximal to the extension 626. In another variation, the length 638 of the shield 608 is equal to the distal end of the annular blade 610. In another variation, the length 638 of the shield 608 extends slightly distally beyond the blade 610. In another variation, the length 638 of the shield 608 is distal of the extension 626. The length 638 of the shield 608 is adapted to surround the depending portion of the morcellator 602, in particular the blade 610. By surrounding the blade 610, the shield 608 guards the blade 610 from inadvertently contacting the surrounding tissue and the storage bag.

  In use, the tissue storage bag is placed through a small incision in the abdomen or a small orifice or opening in the body. This is accomplished by compressing the flexible ring of the bag into a low profile configuration and inserting the bag through the small incision / opening. The flexible ring is spring openable within the body cavity to expand the mouth portion of the bag and facilitate the placement of the cut piece of target tissue into the bag. The target tissue is placed in the bag while the bag is in the abdominal cavity. A retractor can be used and can be placed inside the incision. The ring on the bag is then pulled through the incision using the tie on the bag. Roll the ring on the bag on itself and roll the side walls of the bag around the ring to reduce the length and size of the bag, thereby making the specimen inside the bag closer to the incision / opening Pull on. Specimens inside the bag are viewed with the naked eye near the mouth of the bag. The shield 608 is rotated while external to the patient to minimize size by rolling or curling the shield 608 on itself into a tighter configuration. While in the reduced configuration, the shield 608 is disposed in the bag within the incision / opening and is self-expanding or diametrically expanded to open the incision by reversing the rotation of the shield 608 Maximize the department. The extended position can be fixed with a lock of the type described herein. Anchor 608 is anchored to larger dimensions. The C-shaped outer surface 634 of the shield 608 is properly anchored within the incision such that the abdominal wall sits within the concave surface of "C". The support barbs 606 are advanced through the central lumen 618 of the morcellator 602 and used to grasp the target tissue while the target tissue is being viewed with the naked eye. Once the tissue is properly grasped, it is held by the support wedge 606 and the depending portion of the molserator 602 including the blade cylinder 612, the inner cylinder 614 and the outer cylinder 622 is within the central lumen 636 of the shield 608. And move or slide downwardly along the length of the support bar 606 until the distal end of the morcellator housing 616 abuts the proximal end 628 of the shield 608. The support bar 606 can be pulled proximally to bring the specimen into contact with the blade 610 of the morcellator 602. The morcator 602 is started to rotate the blade cylinder 612 at high speed. The support rod is withdrawn proximally while holding the sample. The grasping tissue is pulled into the cutting blade of morcellator 602 using a support rod. The extension 626 of the outer cylinder 622 prevents the entire circumference of the blade 610 from cutting through tissue simultaneously. This prevents coring and allows the blade 610 to move along the specimen, resulting in a larger specimen portion that is excised in one piece. After all of the tissue has been removed or reduced to a piece having a size that can pass through the incision, the shield 608 and the bag are removed. The shield 608 advantageously protects and retracts adjacent tissue at the incision and carding from adjacent contact of the storage bag with the cutting blade 610. The present invention also avoids forming a secondary opening in the storage bag to insert the scope to visualize the morsulation procedure. Secondary openings, which may damage the closed storage system, are advantageously avoided by this morcellation system 600. The molarity in the body cavity can spread potentially harmful fragments of the analyte being morsulated. Therefore, molaring in a closed system is desired. Placing the sample in the storage bag creates a closed system as the opening of the bag is brought to the surface through the incision, thereby isolating the sample inside the bag and with the tissue in the body cavity. Isolate from contact. Previous solutions for visualization require forming another opening in the bag and placing the laparoscope through the opening so that the closed system is no longer maintained. Alternatively, the scope may be placed through the same incision as the morcellator, but this results in poorer visibility and triangulation performance needed for optimal viewing. The shield 608 advantageously enables the use of a cutting mechanism including a powered molserator in the closed system while preventing potential breach of the closed system. The molaration system 600 allows for visibility of the specimen without a laparoscope by bringing the specimen to the surface as the bag is retracted. The morcellation system 600 maintains and ensures a closed system throughout the morsulation procedure by reducing damage to the tissue storage bag through the use of the shield 608 with a corresponding short molserator. The length of shield 608 is approximately equal to the length of the protruding portion of morcellator 602. A shield 608 surrounds the blade 610 and is located between the bag and the morcellator 602. The shield 608 opens and holds the incision opening so that the specimen can be easily visualized and removed. The shield 608 protects the bag and tissue from damage by the cutting blade 610 or the support wedge 606 at the incision site. The outer cylinder 622 of the morcellator is surrounded by a shield 608, which prevents accidental contact between the blade 610 and the storage bag which can result in a break in the closed system. The shield 608 forms a protective cage around the blades to ensure safe molaration. In one variation, the length 638 of the shield 608 in the unexpanded configuration is approximately one inch, and the length 640 of the morselator cylinder is also approximately one inch.

  Referring now to FIGS. 89-90, a molaration system 600 using an energy based morcellator 602 is shown. The energy based molaration system utilizes the tissue storage bag, support rod, shield 608 in the same manner as described above. Rather than rotating the blade 610 to cut tissue, the circular blade 610 remains stationary. The blades 610 and cylinders 612 of the morcellator 602 are connected to the monopolar energy system 652 via an energy input 650. The support rod 606 is connected to the plug 654 to ground on the monopolar energy system 652. When the target tissue is grasped by the support wedge 606 and brought up to the blade 610, monopolar energy is activated to cut the tissue. The extension 626 serves the same purpose as described above. An exhaust port 656 is provided on the housing 616 to prevent smoke inhalation from the cutting process.

  Referring now to FIGS. 91-103, a shield 700 adapted for placement in the vaginal canal is shown. The shield 700 has the same form as the shield described herein. The shield 700 is substantially formed from a band of material having an inner first end 702 and an outer second end 704 interconnected between the proximal end 706 and the distal end 708. Cylindrical / tubular. Shield 700 includes an outer surface 710 and an inner surface 712. The inner surface 712 defines a central lumen 714 extending along the longitudinal axis from the proximal end 706 to the distal end 708. The central lumen 714 is shown in a circular shape and in another variation can have an oval or elongated oval oval shape. The proximal end 706 defines a radially outwardly extending proximal flange 716 that forms a funnel-like entry into the central lumen 714. The outer surface 634 is concave and gradually flares radially outward towards the distal end 708. In another variation, the distal end 708 is generally non-flared but substantially cylindrical with a substantially constant diameter distal to the funnel-like flange 716 at the proximal end. At least a portion of the shield 700 overlies itself when in the relaxed normal configuration. In another variation, the shield 700 does not overlie itself when in the relaxed configuration. The shield 700 can be curled onto itself to reduce the lateral diameter to facilitate insertion into the vagina or other orifice or wound incision. The overlapping parts of the shield 700 follow each other and nest. The shield 700 is configured such that one end, eg, the first end 702, slides relative to the second end 704. The shield 700 can have a first reduced lateral or diametrical dimension suitable for easy insertion into the vagina or other body opening. Reduced lateral position is achieved by curling the shield 700 on itself into a tighter, smaller configuration. Shield 700 also includes a relaxed normal position having a second lateral or diametrical dimension. The second lateral or diametrical dimension is larger than the first lateral / diametrical dimension. The shield 700 is shaped to have a bias biased to a normal relaxation position, and when reduced to a first diametrical position, the shield 700 has its second lateral or diametrical dimension and its relaxation. There is a tendency to automatically expand or spring open or anchor towards a normal position. The shield 700 can be provided with a lock of the type described herein that fixes the lateral or diametrical position. Shield 700 also includes an enlarged configuration having a third lateral or diametrical dimension. The third lateral or diametrical dimension is larger than the second lateral or diametrical dimension. The expanded configuration is accomplished by curling shield 700 in the opposite direction or anchoring shield 700 to open central lumen 714. Any of these positions and any intermediate position of the lateral dimension of the shield 700 can be locked in place via the lock. The shield 700, and particularly the expanded configuration of the shield 700, serves to retract tissue and open the orifice or wound to provide a safe working channel for surgical procedures.

  As can be seen in FIGS. 93-94, the first end 702 and the second end 704 each have an S-shaped curvature that overlies the outer surface 710 of the adjacent shield portion. The S-shape transitions into notches 718, 720 near the proximal end 706 and the distal end 708, respectively. The notches 718, 720 form a lock configured to fix the lateral dimension of the shield 700. The notches 718, 720 are shown in FIGS. 93-94 in the unlocked position and in FIGS. 97-98 in the locked position. The notches 718, 720 form finger-like extensions that mate together to lock the shield 700 in place. In FIGS. 97-98, finger-like extensions near the notch 718 of the outer second end 704 overlap the inner first end 702 to lock the shield 700. As mentioned above, the outer surface 710 of the shield 700 forms a concave surface having inflection points 722 as seen in FIGS. 93-94. The inflection point 722 is located near the proximal flange 716 and above an intermediate plane taken perpendicular to the long axis. The proximal flange 716 acts as a protective surface, guarding the storage bag, the retractor 724 and vaginal canal tissue in the inserted position. The shields and / or the flanges are made of rigid, rigid or semi-rigid plastic or cut resistant material. The proximal flange 716, and in particular the inner surface 712 of the proximal flange 716, provides a cutting board-like surface against which storage bags, adjacent tissue or adjacent tissue or advantageously using sharps such as a scalpel or blade The target tissue can be cut and shrunk without the risk of cutting the retractor.

  With particular reference now to FIGS. 99-103, a shield 700 for use in combination with the retractor 724 is shown. The retractor 724 is the same retractor 62 as described with respect to FIGS. 18-19. Retractor 724 includes a first ring 726 and a second ring 728 interconnected by flexible side walls 730. Side wall 730 defines a central opening extending along the longitudinal axis of retractor 724. The second ring 728 can be compressed and inserted through the vaginal canal where it expands and abuts the vagina to form a anchor. The first ring 726 is external to the patient and above the vaginal entry where it can be rolled down to retract and expand the vaginal canal.

  In hysterectomy, the uterus is peeled from the body by an instrument inserted through the abdominal port. After the uterus has been dissected, the shield 700 can be inserted directly into the vaginal canal. In such a variation, the shield 700 curls on itself into a reduced configuration to assist in the insertion of the shield 700 and, when in position, eases the shield 700 while inside the vaginal canal The configuration is expanded, thereby expanding and retracting the vaginal opening. The proximal flange 716 is near the vaginal entry. The abraded uterus can be grasped and drawn into the central lumen 714 of the shield 700, and the blade can be used to molarate the uterus with a blade, reducing the size of the uterus or into pieces, through the vaginal canal It becomes possible to remove completely.

  In another variation, the storage bag can be placed inside the abdominal cavity either through the abdominal port or through the vaginal canal. The removed uterus is placed in the storage bag. Pull the storage bag tie through the vaginal canal. The storage bag ring is compressed into a low profile configuration to facilitate pulling the proximal end of the storage bag through the vaginal canal. The ring of the storage bag is pulled out of the body and expanded to the open configuration, thereby opening the storage bag's mouth. The ring on the storage bag is outside the vaginal opening. The storage bag ring can be rolled down to roll the side walls of the bag over the storage bag ring. This action brings the removed uterus inside the bag closer to the vaginal opening. The shield 700 is then inserted into the mouth of the storage bag and into the vaginal canal. The shield 700 can be curled into a compact configuration to aid in insertion. The proximal flange 716 is at or near the vaginal entrance. In one variation, the proximal flange 716 of the shield 700 is snapped under the ring of the storage bag. The removed uterus can be grasped with a grasper and drawn into the central lumen 714 of the shield 700 where the molaration can begin.

  The distal end of the shield 700 is funnel shaped with a radial dimension that gradually increases from the inflection point 722 towards the distal end 708 of the shield 700. This funnel-like shape advantageously assists in moving the abraded uterus into the shield 700. The uterus is molared with a blade while at least partially present in the shield 700 before being completely removed in whole or in part. The shield 700 advantageously protects the surrounding vaginal canal as well as the storage bag from sharp blades, and helps maintain the integrity of the storage bag and the closed molaration system.

  In another variation, the same procedure is followed as in the previous paragraph, but the retractor 724 is inserted into the mouth of the storage bag after placing the uterus in the storage bag and pulling the ring of the storage bag out of the body. The second ring 728 of the retractor 724 is compressed for easy insertion into the mouth of the storage bag and then expanded inside the storage bag to an open configuration at a location distal to the vaginal canal inside the abdominal cavity. The first ring 726 of the retractor 724, which is external to the body, is rolled about itself to roll the sidewall 720 of the retractor 724 onto the first ring 726. This action not only retracts the vaginal canal, but also retracts the storage bag from the path, freeing the vaginal canal for insertion of the shield 700. A storage bag is captured between the retractor and the vaginal canal to keep it in place and prevent it from moving into or out of the vaginal canal. The shield 700 is then inserted into the central lumen of the retractor 724 inside the storage bag. If necessary, the shield 700 can be curled down into a compact configuration and then expanded to self anchor the shield 700 in place. The shield 700 is then connected to the first ring 726 of the retractor 724 by snap-fitting the proximal flange 716 of the shield 700 below the first ring 726, as shown in FIGS. The uterus can then be grasped with a surgical instrument and drawn out of the pouch of the storage bag into the central lumen 714 of the shield 700, where the uterus can be completely or completely removed before removal. While at least partially within, it is morseled with a blade. The shield 700 advantageously protects the surrounding vaginal canal as well as the storage bag from sharp blades, and helps maintain the integrity of the storage bag and closed molseration system while allowing the surgeon to molese Provide a mechanism for safety and promptness.

  In another variation, the same procedure is performed as in the previous paragraph except that the retractor 724 is placed in the vaginal canal before the storage bag with the sample therein is pulled through the vaginal canal. In this variation, the removed uterus is placed inside the storage bag located inside the body cavity, and a tie strap attached to the proximal end of the storage bag is pulled by the grasper through the central lumen of the retractor to ring the storage bag And bring the mouth out of the patient. The ring on the storage bag can then be rolled down to bring the peeled uterus close to the opening. Thereafter, the flexible retractor 700 is curled onto itself to reduce the size in the direction of the shield 700 to a compact configuration and then release the shield 700 to expand it laterally from the compact configuration. Forced to make it expand by its bias. As the shield 700 expands, it self-locks and retracts the storage bag to create a working channel through the central lumen 714 of the shield 700 for movement and molaration of the abraded uterus. The proximal flange 716 of the shield 700 can be snapped under the ring of the storage bag or the first ring 726 of the retractor 724. The storage bag is captured between the retractor 724 and the shield 700, which keeps it from sliding proximally or distally during the procedure. The flange 726 can also serve as a cutting board-like surface, and a sharp blade can be used on it to cut the uterus for removal. For all of the above hysterectomy procedures, the storage bag and retractor combination of FIG. 20 can be used in place of one or more of the storage bag and retractor 724 combinations.

  In yet another variation, the shield 700 is used with the retractor 724 shown in FIGS. In such variations, the retractor 724 is placed in the vaginal canal. The uterus is dissected using standard techniques before or after placing the retractor 724 in place. The second ring 728 of the retractor 724 is compressed for easy insertion into the vaginal canal and then expanded to an open configuration at a distal location of the vaginal canal inside the abdominal cavity. The first ring 726 of the retractor 724 present outside the body is rolled around itself to roll the sidewall 720 of the retractor 724 onto the first ring 726. This action retracts the vaginal canal. The shield 700 is then inserted into the central lumen of the retractor 724. If necessary, the shield 700 can be curled down into a compact configuration and then expanded to self anchor the shield 700 in place. The shield 700 is then connected to the first ring 726 of the retractor 724 by snap-fitting the proximal flange 716 of the shield 700 below the first ring 726, as shown in FIGS. The uterus can then be grasped with a surgical instrument and drawn into the central lumen 714 of the shield 700, where the uterus is at least partially within the shield 700 before being completely removed in whole or in part. While being present on the blade and are morseled with a blade. The shield 700 advantageously protects the surrounding vaginal canal as well as the retractor 724 from sharp blades, while providing the surgeon with a mechanism for safely and quickly carrying out the molaration.

  Referring now to FIGS. 104-107, another variation of shield 800 adapted for use in the vaginal canal is shown. Shield 800 includes a top end 802 and a bottom end 804 interconnected by side walls 806. An opening 808 is formed in the shield 800, which extends through the top end 802 and the bottom end 804. Shield 800 further includes a first flange 810 and a second flange 812. The first flange 810 extends distally from the bottom end 804. The first flange 810 is curved to form a concave elongated surface towards the longitudinal axis 816. The first flange 810 can also be a substantially flat elongated surface. The first flange 810 includes a distal end 814 angled away from the longitudinal axis 816. The second flange 812 extends distally from the bottom end 804. The second flange 812 includes a hook 818, which is configured to be attached to the storage bag ring or the proximal ring of the retractor by snapping under the ring. 106-107 illustrate shield 800 connected to retractor 724. FIGS. The retractor 724 is the same retractor as described above with respect to FIGS. 18-19 and 99-103. Retractor 724 includes a first ring 726 and a second ring 728 interconnected by flexible side walls 730. Side wall 730 defines a central opening extending along the longitudinal axis of retractor 724. The second ring 728 can be compressed and inserted through the vaginal canal where it expands and abuts the vagina to form a anchor. The first ring 726 is external to the patient and above the vaginal entry where it can be rolled down to retract and expand the vaginal canal.

  Here, the shield 800 is described for use in a surgical procedure such as hysterectomy, but the invention is not limited to use in hysterectomy, and may be used for removal of any target tissue and morcellation procedure. It can apply. In hysterectomy, the uterus is peeled from the body by an instrument inserted through the abdominal port.

  In one variation, shield 800 is used with retractor 724 as shown in FIGS. 106-107. In such variations, the retractor 724 is placed in the vaginal canal. The uterus is dissected using standard techniques before or after placing the retractor 724 in place. The second ring 728 of the retractor 724 is compressed for easy insertion into the vaginal canal and then expanded to an open configuration at a distal location of the vaginal canal inside the abdominal cavity. The first ring 726 of the retractor 724 remains out of the body and rolls around itself rolling the sidewall 720 of the retractor 724 onto the first ring 726. This action retracts the vaginal canal. The shield 800 is then inserted into the central lumen of the retractor 724 and connected to the retractor 724. The shield 800 is configured by snapping the second flange 812 of the shield 800 from the inside of the first ring 726 below the first ring 726, as shown in FIGS. Connected to the ring 726 of Additional hooks can be provided to connect the shield 800 to the retractor 724. The shield 800 covers or is capped on the first ring 726 of the retractor 724 and one or more hooks 818 are hooked under the first ring 726 to retract the shield 800. Fix to 724. The uterus can then be grasped with a surgical instrument and pulled proximally and placed on or juxtaposed to the first flange 810. The first flange 810 of the shield 800 is curved and advantageously exfoliated while the surgeon cuts the uterus to reduce its size using a blade for removal through the vaginal canal The uterus is cradled like a cradle, preventing it from sliding off the first flange 810. The first flange 810 advantageously serves as a cutting board-like surface against which the blade can be safely used to rest tissue that rests near or in contact with the first flange 810 It can be cut off. The angled distal end 814 of the first flange 810 provides additional vaginal dilation and provides a ramp for proximal movement and guidance of the uterus towards the vaginal canal and the vaginal opening. At the proximal end of the shield 800, the ring-like portion of the shield 800 advantageously retracts the labia and safely diverts it from the path of the morcellation blade. The uterus is molared with a blade while at least partially present in the shield 800, before being completely removed in whole or in part. The shield 800 advantageously protects the surrounding vaginal canal, the labia and the retractor 724 from sharp blades while providing the surgeon with a mechanism to safely and quickly perform the molaration.

  In another variation, the storage bag can be placed inside the abdominal cavity either through the abdominal port or through the vaginal canal. The removed uterus is placed in the storage bag. Pull the storage bag tie through the vaginal canal. The storage bag ring is compressed into a low profile configuration to facilitate pulling on the storage bag proximal end. The ring on the storage bag is pulled out of the body and expanded into an open configuration, opening the storage opening. The ring on the storage bag is outside the vaginal opening. The storage bag ring can be rolled down to roll the side walls of the bag over the storage bag ring. This action brings the removed uterus inside the bag closer to the vaginal opening. The shield 800 is then inserted into the mouth of the storage bag and into the vaginal canal and the second flange 812 is hooked to the ring and connected to the ring of the storage bag to secure the shield 800 to the bag. The removed uterus in the bag is grasped with a grasper and pulled onto the first flange 810 of the shield 800. The angled distal end 814 of the first flange 810 assists in guiding and tilting the uterus to a predetermined position, and supports the uterus like a cradle for molseration. The uterus is molared with a blade while at least partially adjacent to the first flange 810 before being completely removed in whole or in part. The shield 800 advantageously protects the surrounding vaginal canal as well as the storage bag from sharp blades, and helps maintain the integrity of the storage bag and the closed molaration system.

  In another variation, the same procedure is followed as in the previous paragraph, but the retractor 724 is inserted into the mouth of the storage bag after placing the uterus in the storage bag and pulling the ring of the storage bag out of the body. The second ring 728 of the retractor 724 is compressed for easy insertion into the mouth of the storage bag and then expanded inside the storage bag to an open configuration at a location distal to the vaginal canal inside the abdominal cavity. Rolling the first ring 726 of the retractor 724 around itself rolls the sidewall 720 of the retractor 724 onto the first ring 726. This action not only retracts the vaginal canal, but also retracts the storage bag from the path, freeing the vaginal canal for insertion of the shield 800. The storage bag is thereby captured between the retractor 724 and the vaginal canal to keep it in place and prevent it from moving proximally or distally along the vaginal canal. The shield 800 is then inserted into the central lumen of the retractor 724 inside the storage bag. The shield 800 is then connected to the first ring 726 of the retractor 724 by snapping the second flange 812 of the shield 800 under the first ring 726 of the retractor 724. The uterus can then be grasped with a surgical instrument and drawn from the pouch of the storage bag into juxtaposition to the first flange 810 of the shield 800, where the uterus is completely or completely removed before removal. While being in contact with the first flange 810 at least partially. The shield 800 advantageously protects the surrounding vaginal canal as well as the storage bag and retractor 724 from sharp blades and helps the surgeon while maintaining the integrity of the storage bag and closed closure system. Provides a mechanism for safely and quickly carrying out the molaration. For all of the above hysterectomy procedures, the storage bag and retractor combination of FIG. 20 can be used in place of one or more of the storage bag and retractor 724 combinations. It is also understood that the present invention is not limited to hysterectomy procedures, but can be applied to the molaration, reduction and removal of any tissue or organ.

  Referring now to FIGS. 108-109, a variation of a shield 900 is shown that includes a funnel 902 having a retraction finger 904 at its distal end. The funnel 902 defines a central opening 906. The proximal end of the shield 900 defines a funnel-like inlet to the central opening and forms a proximal flange surface circumferentially surrounding the central opening 906. The shield 900 is inserted into the orifice or wound incision by inserting the retraction finger 904 first and then inserting or angulating the central portion of the funnel 902 into the opening. The proximal end of the funnel 902 is disposed on the abdomen or other external body surface. The proximal flange provides a cutting board position against which it can morsate tissue. Retraction fingers 904 serve to retract the incision or orifice, helping to anchor shield 900 in place. The retraction finger 904 forms a distal flange which extends around only a portion of the distal circumference of the central opening 906. The retraction finger 904 is curved such that the side profile of the shield 900 at the location of the retraction finger 904 is substantially C-shaped, and the upper portion of the "C" has a longer distance transverse than the lower portion of the "C". It extends in the direction. The funnel 902 also provides protection to the surrounding tissue and storage bag as well as the retractor when used with the shield 900. For example, the storage bag can be inserted through the orifice or incision and after the sample is inserted into the bag, the mouth of the bag is pulled back through the incision. The proximal end of the bag is placed over the abdomen and the shield 900 is inserted into the mouth of the bag and anchored by the retraction finger 904. A grasper is inserted into the central opening 906 and the sample inside the bag is pulled towards the central opening 906. The blade is then used to reduce the specimen for whole or partial removal through the small incision / orifice. The shield 900 is made of hard plastic, of sufficient thickness, to reduce the possibility of penetration by the blade, protect adjacent tissue, and maintain the integrity of the storage bag.

  In another variation, shield 900 is used with a retractor similar to that described above. The retractor is placed inside the incision either before or after placing the bag, and then the shield 900 is inserted into the mouth of the bag and the retractor. In one variation, the proximal end of shield 900 is sized and configured to mate with the proximal ring of retractor or bag by capping or snapping onto the proximal ring of the bag or retractor. A variation of shield 900 adapted to cap on the proximal ring of a retractor or bag is shown in FIGS. 109B and 109C and has an oval central lumen 906 and a circular central lumen 906, respectively. The shield 900 of FIGS. 109B and 109C has at least one hook 905 or clamp configured to attach to the ring of the retractor or bag.

  Referring now to FIG. 109, the funnel 902 includes a circumferential rim 908 rising from the inner surface. The rim 908 is configured to connect with the blade and will be described in more detail below. The funnel 902 also includes a raised portion 910. The raised portion 910 is configured to hold the second shield 912. A second shield 912 is shown in FIG. The second shield 912 is similar to the shield described with respect to FIGS. 71-86 as well as the other shields described herein. In one variation, the second shield 912 is spiral shaped and can be longitudinally collapsed and expandable as described above. In the variation shown in FIG. 110, the second shield 912 is not spiral but substantially cylindrical and has a concave outer surface and a gap 914 to form a C-shaped shield. The second shield 912 includes a proximal flange 916 and a distal flange 918 interconnected by a central portion 920. The proximal flange 916 can include a tab or finger pull that assists in its removal from the orifice / incision. The second shield 912 has a reduced configuration that has a smaller lateral dimension than the normal relaxed configuration shown in FIG. The reduced configuration is optimal for insertion into the wound or orifice and for connecting the second shield 912 to the first shield 900. The second shield 912 is made of a flexible plastic having sufficient properties to prevent penetration by blades or other sharp objects or instruments under normal use to protect adjacent tissue.

  Referring now to FIG. 111, a first shield 900 connected to a second shield 912 is shown. A C-shaped second shield 912 is disposed inside the first shield 900 and the proximal flange 916 of the second shield 912 is on at least a portion of the inner surface of the funnel 902 of the first shield 900 It is supposed to overlap. The raised portion 910 of the shield 900 is received within the gap 914 of the second shield 912. The connection with the rising portion 910 prevents the second shield 912 from moving around inside the funnel 902. The first shield 900 provides protection along a portion of the lower circumference at the location of the retraction finger 904, and the second shield 912 completes the circumferential protection at the distal end. The second shield 912 provides 360 degree circumferential protection at the distal end located within the incision / orifice. Also, the distal flange 918 provides a funnel-like entry into the central lumen 922 of the second shield 912, which aids in moving the tissue into and out of the body of the shields 900,912. Provide protection to the surrounding tissue, storage bag, and retractor if used. The shields 900, 912 can be used with manual blade mortaring, or with a short power molarator similar to that described above with respect to FIGS.

  Referring now to FIGS. 112-113, a blade carrier 926 is shown connected to the first shield 900 and then to the second shield 912 to constitute another variation of the shield system. The blade carrier 926 includes a funnel 928 defining a central opening 930, a blade receiver 932, and a blade 934. The funnel 928 includes a funnel-like shape and a circumferential hook configured to cap the first shield 900, snap-fit thereon, and to be connected thereto. Specifically, as shown in FIG. 113, the circumferential hooks of the funnel 928 connect directly to the raised circumferential rim 908. In one variation, the blade carrier 926 is snapped onto the first shield 900 so that it is held vertically and still allowed to rotate relative to the first shield 900. Blade receiver 932 houses blade 934 within blade channel 936. The blade 934 is connected to the blade handle 938 via a pin 940 connecting the blade 934 to the inner rod 942. Details of the blade housing 932 are also shown in FIGS. 114-115. In one variation, the inner rod 942 with the blade 934 pinned through the pin 940 reciprocates relative to the blade handle 938. Reciprocation may be provided by manually moving the inner rod 942 back and forth relative to the blade handle 938 at the proximal end to cause back and forth movement of the blade 934 at the distal end. Reciprocation can be provided by an electric motor (not shown) located within the blade handle 938 at the proximal end within the removable and reusable handle attachment. The blade receiver 932 can be provided in two parts, a first part and a second part. The first portion includes a blade channel 936 that has a slot 944 configured to receive the pin 940 and configured to guide the translation of the blade 934 within the blade channel 936. One end of the pin 940 is connected to the blade 934 and the other end of the pin 940 is connected to the distal end of the inner rod 942 housed in the second portion of the blade receiver 932 housing the blade 934 together. The blade receiver 932 is connected to the funnel 928 of the blade carrier 926. The inner rod 942 moves distally to expose the blade 934 to cut tissue when in the exposed position. Once the blade 934 is exposed, the blade carrier 926 can rotate relative to the first shield 900 to circumferentially cut tissue along at least a portion of the interior of the central lumen. The blade 934 can be retracted to a retracted position, where the blade 934 is at least partially hidden inside the blade receiver 932. When in the retracted position, the sharp sides of the blade 934 are substantially hidden, allowing the blade carrier 926 to be handled safely. The blade 934 can be moved manually or automatically from the retracted position to the exposed position to cut tissue. The reciprocating cutting motion can be selectively activated manually or automatically by the user when tissue cutting is desired, or can be operated to reciprocate continuously. Also, the reciprocating cutting operation can be performed simultaneously with the rotation of the blade carrier 926 relative to the first shield 900, or can be performed intermittently with respect to the rotation of the blade carrier 926. Moving the blade 934 from the retracted position to the exposed position is such that the blade 934 is in a plane that includes the distal end of the central opening 930, at an angle to that plane, or substantially to that plane. Move vertically. This plane can also be defined as the plane perpendicular to the longitudinal axis of the device or the longitudinal axis of the central lumen. The amount by which the blade 934 is exposed can be selected by the user and selective cutting is performed. For example, blade 934 may be exposed half way from a fully retracted position, in which case blade 934 may not intersect a plane that includes the distal end of central opening 930. The blade 934 is configured to extend beyond the distal end of the central opening 930 of the blade carrier 926 but not beyond the distal end of the second shield 912 so that the blade 934 and its passage are always Ensuring that it is surrounded and surrounded by any one or more of the one shield 900, the second shield 912, and the blade carrier 926. In another variation, the distal end of the blade 934 is allowed to extend slightly beyond the distal end of the second shield 912.

  In one variation, the blade 934 is fixed relative to the blade receiver 932, does not reciprocate relative to the blade carrier 926, and only rotates relative to the first shield 900. In another variation, the blade carrier 926 is fixed relative to the first shield 900 in the sense that it does not rotate relative to the first shield 900, but such that the blade 934 reciprocates relative to the blade carrier 926 Configured The rotational cutting operation aims to guarantee the protection of the surrounding tissue, while increasing the chance that the specimen is removed as a single excision instead of multiple pieces. Also, blade 934 is depicted as curved downward into the central opening. In another variation, the blades 934 extend radially inward in a plane perpendicular to the central lumen and have a configuration similar to a guillotine or cigar cutter. It is within the scope of the present invention for blade 934 to have an approach angle of 0 degrees to 180 degrees, where the approach angle of zero degrees means that blade 934 is in a plane perpendicular to the central lumen longitudinal axis It is to intersect parallel to the long axis at the 12 o'clock position. An approach angle of less than 180 degrees is that blade 934 intersects the plane perpendicular to the long axis from below the plane at a position of about 5 to 7 o'clock.

  FIG. 116 shows the blades 934 of the blade carrier 926. FIG. The blade 934 has a sharp point and a sharp side configured to pierce and cut tissue.

  Referring now to FIGS. 117-119, a shield assembly 950 is shown that includes a blade carrier 926, a first shield 900, and a second shield 912. Blade 934 is shown connected to a blade handle 938 having a motor housed within removable handle extension 946. The first shield 900 includes the cut out 948 seen in FIGS. 109, 111, 117 and 118. The cut outs 948 facilitate separation and removal of the blade carrier 926 from the first shield 900 by providing a space for the blade carrier 926 to click away from the first shield 900 with a finger.

  Referring now to FIGS. 120-126, another variation of the shield assembly is shown. The shield assembly includes a first shield 900, a second shield 912 and a blade carrier 926. The blade carrier 926 comprises a blade receiver of two parts 932a, 932b, a blade 934, an inner rod 942, a pin 940 and a blade handle 938. The length of the blade handle 938 is not shown to scale and is drawn for illustration purposes, and in configurations where the shield assembly is disposable, the reusable handle extension 946 is proximal to the blade handle 938 Includes variations that can be attached to the end. The variations of FIGS. 120-126 are substantially similar to the variations shown in FIGS. 109-119, with some modifications. The second shield 912 is of the nature of the spiral as described above instead of that of the cut cylinder. The second shield 912 is shown in a compressed configuration in FIG. The first shield 900 includes an outer rim 908 located around the top of the first shield 900. The funnel 928 of the blade carrier 926 snaps under the outer rim 908 in the variation shown in FIGS. 120-126.

  In another variation of the shield, the shield is molded around a helicoid (helical surface) whose cross section perpendicular to the helical guide path is parabolic. Once the mold is removed, the helical surface is compressed on itself into the form of a catenoid, which remains in that state during its rest state. The following parametric equations cover variations of the shield.

x (u, v) = β [cos (α) sin h (v) sin (u) + sin (α) cosh (v) cos (u)] (1)

y (u, v) = γ [-cos (α) sin h (v) cos (u) + sin (α) cosh (v) sin (u)] (2)

  z (u, v) = δ [u cos (α) + v sin (α)] (3)

  The value α is a fixed parameter which changes the state of progression of the transformation from helicoid to catenoid. When α = 0, helicoids are produced, and when α = π / 2, catenoids are produced. The variation of the shield has a value of α greater than 0 and less than π / 2, which can be regarded as an open interval (0, π / 2). Another variation of the shield has a value of α greater than 0 and less than or equal to π / 2, which can be considered as an open interval (0, π / 2). Another variation of the shield has a value of α greater than or equal to 0 and less than π / 2, which can be considered as an open interval (0, π / 2). The parameters β, γ, δ are also fixed constants. When β, γ, δ∈R \ {0}, and when β <0, γ <0, δ <0, the rotation is counterclockwise. When any of β, γ, δ> 0, the rotation rotates clockwise. The surface is constructed on the uv plane according to the parametric equation. The values for the vectors u and v can be regarded as uε (−π, + π) and vε (−∞, + ∞).

  Referring now to FIG. 127, another variation of a storage bag 1000 according to the present invention is shown. The bag 1000 includes a side wall 1002 defining an opening 1004 at the proximal end. The bag 1000 has a major axis substantially perpendicular to the opening 1004. Side wall 1002 may form a bag 1000 of any shape, such as cylindrical, elongated, spherical, etc., and may include or include a base or bottom panel from which side wall 1002 extends towards the distal end. It does not have to be. The sidewall 1002 can extend downward to define a seamed or seamless base. For example, the bag 1000 can be formed of a planar length of material, folded and joined along its sides, seams are not formed along the base, but instead It is disposed on the side of the bag 1000 and extends upwardly substantially perpendicularly to the longitudinal axis.

  Still referring to FIG. 127, the storage bag 1000 includes at least a first ring 1006 disposed at or near the opening 1004 of the bag 1000. The first ring 1006 is connected to the bag 1000. The second ring 1008 is shown in FIG. The second ring 1008 is spaced below the first ring 1006 and connected to the bag 1000. The first ring 1006 and the second ring 1008 are elastic and are suitable for passing through a small incision, a body orifice or through the trocar's lumen from an expanded configuration which is circular or oval shaped It is compressible into a collapsed elongated configuration having a reduced lateral dimension. In one variation, the second ring 2008 is not used. The bag 1000 can be crushed to a shorter length along the longitudinal axis of the bag 1000. The squeezed bag 1000 is then elongated and easily compressed and squeezed laterally by subsequently squeezing the first ring 1006 and the second ring 1008 if the second ring 1008 is used. It is configured and deployed in the abdominal cavity. Inside the abdominal cavity, the compressed rings 1006, 1008 can return to their original expanded open configuration. With the rings 1006, 1008 in the expanded configuration inside the abdominal cavity, the bag 1000 can be easily oriented in the abdominal cavity. Locations within the circumference of the rings 1006, 1008 are targets for placing the resected tissue or organ. In one variation, the collapsing configuration of the bag 1000 can be used to place the specimen within the boundaries of the first and second rings 1006, 1008 on either side, so the front side should be on top Absent. The first ring 1006 acts as an outer circumferential guide for placing the specimen within the outer circumference of the first ring 1006, so the first ring 1006 is a bright color or the rest of the bag 1000 Alternatively, the color may be contrasted with the intended surroundings so that it can be easily observed laparoscopically. After placing the resected tissue or organ inside the perimeter of the first ring, the first ring 1006 is moved towards the outlet incision or orifice. Lifting of the ring 1006 causes the resected tissue to move or fall deep into the interior space 1010 of the bag 1000. Moving the bag to the outlet opening causes the tissue specimen to be seated in the interior space 1010 of the bag 1000. The first ring 1006 is compressed into an elongated, reduced configuration and withdrawn through the outlet orifice, opening or outlet incision. Once past the opening, the first ring 1006 expands by itself and springbacks to an open expanded configuration, overlapping it near the exit orifice, opening or exit incision, on the abdominal wall or on Be present outside the patient. The first ring 1006 is rolled or flipped by inverting the first ring 1006 outwards or inwards to roll the bag 1000 onto the first ring 1006. The first ring 1006 can be rolled in the reverse direction to deploy the bag 1000 from the first ring 1006. In one variation, the cross section of the first ring 1006 has a length greater than its width. The elongated cross section of the first ring 1006 advantageously keeps the bag side wall 1002 rolled up on the first ring 1006. If the cross section of the first ring 1006 is circular, the first ring 1006 can more easily roll or unroll to roll or unroll the sidewall 1002 relative to the first ring 1006. The rolling of the first ring 1006 around itself pulls the bag 1000 upwards, bringing the specimen inside the bag 1000 closer to the opening. The rolling action of the first ring 1006 reduces the distance of the side wall 1002 between the first ring 1006 and the second ring 1008, such that the second ring 1008 is closer to the first ring 1006. The abdominal wall is anchored between the first ring 1006 and the second ring 1008, and the bag 1000 is secured to the patient to ensure molaration. The rolling action of the bag 1000 reduces the volume of the bag 1000 and also forms a well formed pin and tight protective apron around the opening as well as the patient exterior around the opening. The rolling action also plays a role in retracting the tissue at the opening, conveniently enlarging the opening and facilitating the removal of the tissue from inside the bag 1000. The tissue specimen is then withdrawn from the bag 1000 by being sized manually and manually through a blade or automatically through an electronic morsator to pass through the opening and out of the bag 1000. After the tissue sample is removed from the bag, the first ring 1006 is unrolled to loosen the space between the two rings 1006, 1008, if necessary. The second ring 1008 is then compressed into an elongated, reduced configuration and withdrawn through the opening out of the patient, removing the bag 1000 from the patient.

  The bag 1000 and / or the side wall 1002 of the bag 1000 is formed of a material that is extremely resistant to cutting by sharp objects such as a blade of a scalpel and a blade used in an electronic morsator. In one variation, the bag 1000 is formed of a highly cut resistant textile material such as DYNEEMA® fiber. The cut resistant material is ultra high molecular weight polyethylene (UHMWPE), also known as high modulus polyethylene or high performance polyethylene. In one variation, the bag 1000 is made of DYNEEMA® coated with an elastomer to prevent fluid transfer to the material surface. In one variation, the entire bag 1000 is made of a cut resistant material. In another variation, only selected portions of the bag 1000 are made of cut resistant material. In one variation, the portion of the sidewall 1002 of the bag 1000 located between at least the first ring 1006 and the second ring 1008 is made of a cut resistant material. In another variation, only a portion of the bag 1000 that is expected to be cut is made of cut resistant material. In another variation, the bottom portion of the distance between the two rings 1006, 1008 is made of a cut resistant material and the upper portion of the distance between the two rings 1006, 1008 is rolled onto the first ring 1006 It is left to be able to do it. In another variation, the upper portion of the distance between the two rings 1006 is made of the same cut resistant material, but the thickness or fiber thickness is less than the thickness of the side wall or the fiber thickness of the bottom portion. In variations where a portion of the bag 1000 is made of a cut resistant material, the remaining portion is formed of the suitable polymeric material described above. In one variation, the use of a bag 1000 made of cut resistant material eliminates the need to use the above-described retractor in combination with the bag 1000 in a morsellation procedure. Thus, the bag 1000 advantageously serves not only to provide cut-off resistance and safety shield during morseration, but also to retract the opening into which it is inserted. Because the bag 1000 is cut resistant, it can be used without shields / guards of the type described above. The absence of a shield or guard can advantageously provide more work space.

  Embodiments of the bag 1000 include sheets, membranes, fibers, and / or strands of one or more materials that provide the sheath with abrasion resistance and puncture resistance in addition to cut resistance. Suitable sheets, membranes, fibers and / or strands comprise at least one of natural polymers, semi-synthetic polymers, synthetic polymers, metals, ceramics, glasses, carbon fibers, carbon nanotubes and the like. Suitable natural polymers include cellulose, silk and the like. Semi-synthetic fibers include nitrocellulose, cellulose acetate, rayon and the like. Preferred synthetic fibers are polyester, aromatic polyester, polyamide (NYLON (R), DACRON (R)), aramid (KEVLAR (R)), polyimide, polyolefin, polyethylene (SPECTRA (R)), polyurethane , Polyurea, polyvinyl chloride (PVC), polyvinylidene chloride, polyetheramide (PEBAX (registered trademark)), polyether urethane (PELLETHANE (registered trademark)), polyacrylate, polyacrylonitrile, acrylic, polyphenylene sulfide (PPS), Polylactic acid (PLA), poly (diimidazopyridinylene-dihydroxyphenylene) (M-5), poly (p-phenylene-2,6-benzobisoxazole) (ZYLON (registered trademark)), liquid crystal polymer Such mer fiber (VECTRAN (TM)), and blends thereof, copolymers, composites, and mixtures thereof. Suitable metals include stainless steel, spring steel, nitinol, superelastic materials, amorphous alloys and the like. The bag 1000 includes retractor integration and provides both features of specimen storage and tissue retraction. Additional retraction features and materials and configurations incorporated into the bag 1000 in a variation of the present invention are described in US Pat.

  Currently available morserators generally cut tissue within a body cavity with an exposed unprotected device such as a sharp blade or energy tip. For most molserators, this creates an additional risk as the exposed blade / tip can easily come in contact with unintended sites and damage organs, tissues, blood vessels etc. As current molceraters tear tissue in the open area, small pieces of cut tissue may be left after the tissue removal procedure. These pieces can lead women to endometriosis where uterine cells attach to other organs or cell walls. These pieces may also contain cancer cells that must be completely removed. Currently, when the tissue is expected to be cancerous, the entire mass is removed rather than laparoscopically, which increases the patient's risk of infection and increases the time to recovery. Even if all the pieces are found, the extra step of looking for smaller tissue pieces in the body cavity further adds to the surgical time. In addition, current morserators require two people to perform the procedure. One has to pull the tissue through the morcellator with a support rod while the other has to keep the remaining tissue mass from within the body cavity near the tip of the rotating blade. As the procedure is being performed, the specimen usually falls or falls off the device holding the specimen in place during the molaration. This means that the person responsible for positioning the specimen in front of the morcellator has to find the tissue and re-clamp the instrument against it before placing the specimen again in front of the molserator. It will take more time. Thus, although it is desirable to molse in a bag or the like, the bag itself is subject to potential puncture and the contents are susceptible to spillage. One variation of the present invention is a sample bag having a protective inner layer of material resistant to puncture by the jaws of the support wedge and the blades of the rotating morcellator. Also, since the morcellator is locked in the resting position using any of the aforementioned stabilizers, the likelihood of the blade contacting the bag is greatly reduced. Because the sample bag contains the entire tissue sample, even if small pieces fall from the large sample during molseration, they are removed when the bag is withdrawn from the patient. This increases patient safety and reduces operating time for the morcellation procedure since it is not necessary to look for remaining tissue pieces. The specimen bag supports the tissue and holds it in place. This makes it possible to perform the morseling procedure by one person instead of two people. This also reduces the time required to constantly reposition and reclamp the specimen.

  Referring now to FIGS. 128-134, the tissue morcerator 3000 captures tissue specimens such as the uterus inside the human body under laparoscopic conditions and includes small incisions, orifices, openings (which include laparoscopic ports) A multi-component medical device used to reduce the size to a size that can be removed (with or without). The molserator 3000 includes a gear housing 3016 that houses the gear train, which can be clearly seen in FIG. 133, which is connected at its proximal end to a connected flexible transmission shaft 3018 of the motor, The morcator blade 3010 is rotated. The morcellator 3000 has a central working channel lumen 3020 extending through the length of the morcellator 3000. The inner and outer tubes of morcellator 3000 are stationary with respect to the moving blade 3010 and do not rotate and provide a moving surface to the tissue as it is removed through the lumen 3020 . In one variation, morcellator 3000 includes a camera 3022. The camera 3022 can be integrally formed with the remainder of the morcellator 3000 or, as shown in FIG. 134, include a separate add-on that slides on and connects with the morcellator 3000. Can. As further seen in FIG. 132, the distal end of the morcellator shaft includes a fixed projecting appendage covering at least a portion of the distally extending blade, interrupting tissue molaration. And prevent tissue from rotating relative to the instrument.

  With continued reference to FIGS. 128-134, the morcellation system further includes an elongated shaft 3028 and a jaw-like grasper at the distal end controlled by a handle 3024 at the proximal end that opens and closes jaws 3026 to grip tissue. And a support rod 3012. The shaft 3028 and the jaws fit inside the working channel 3020 of the morcellator 3000 and are configured to extend out and project out of the distal end of the morcellator shaft. The handle 3024 of the support rod is designed to be held longitudinally with either the left or right hand, this ergonomic design is intended to optimize the movement of the hand and arms pulling upwards . The handle 3024 includes a lever 3030 that closes the jaws 3026 by gripping towards the handle 3024 as shown in FIG. Alternatively, the lever 3030 can be held tight to open the jaws 3026. Because the lever 3030 is under spring tension, the lever 3030 can spring open away from the handle 3024, which can define the closed configuration of the jaws 3026, at which time the user pulls the support bar 3012 upward to It is possible to concentrate on extracting the Alternatively, the trigger is under spring tension and the lever 3030 is spring open away from the handle 3024 and the jaws 3026 open.

  With particular reference now to FIGS. 130-132, the jaws 3026 of the support bar include a curved distal tip 3032. The jaws 3026 include upper and lower jaws hinged together. Each of the upper and lower jaws includes a rounded curved distal end that does not have any sharps along the curve traced by the distal end 3032 as the jaws 3026 open and close . In the closed configuration shown in FIGS. 130, 131, the curved distal end 3032 does not present an exposed sharp point or edge that can pose a risk to the integrity of the tissue or bag when in the open or closed configuration. . The interior of the upper and lower jaws includes teeth 3034. Also, the distal tip 3032 includes teeth 3034 interlocking from the upper and lower jaws to provide an active catch on the grasped tissue while providing a smooth curved outer surface, any surrounding tissue and / or Or also protect the bag. FIG. 132 shows the jaws 3026 in an open configuration and shows the path 3036 followed by the distal end 3032 upon opening and closing the support bar. The curved distal end 3032 advantageously protects the bag being morsulated from being punctured when the tissue is gripped. Even when the jaws 3026 are fully open, the curved distal end 3032 of the jaws can protect the bag from unwanted punctures.

  Referring now to FIGS. 135A-135D and 136A-136B, the molaration system includes a specimen collection receptacle bag 3002. The described molaration system can be adapted for use with a powered molarator as described above, or can be used with manual molaration. The bag 3002 is shown flat in FIG. 135A and rolled up in FIGS. 135B and 135C. Bag 3002 includes a bag ring 3004 that surrounds the opening or mouth of bag 3004. FIG. 136A shows a state where the tissue sample 3006 is captured inside the bag 3002 and the bag ring 3004 is pulled out to the outer surface. FIG. 136B shows the bag ring 3004 fully withdrawn through the body opening to expose the inside of the bag 3002 to the outside of the body in order to remove the specimen 3006 inside the bag 3002. In FIG. 136B, tissue guard 200 is shown ready for insertion into a body opening. Although tissue guard 200 is shown, any tissue guard according to the present invention can be used.

  Referring to FIGS. 137A-137C and 138A-138C, another variation of the bag 3002 is shown. The bag 3002 includes a bag ring 3004 having an elongated cross section as the cross section shown in FIG. 137C. The bag 3002 of FIGS. 137A-C is configured to be rolled down to wrap the sidewall of the bag 3002 around the bag ring 3004. FIG. 138A shows a bag 3002 with a sample of tissue 3006 inside it. The bag ring 3004 is pulled out to the surface of the body through the body opening. FIG. 138B shows the bag ring 3004 fully withdrawn to the surface, and FIG. 138C shows the bag ring 3004 as shown by the arrows in FIG. 138C and as previously described herein. It shows the contents of the bag brought closer to the surface, which can be rolled or flipped around itself, reducing the length of the side walls of the bag and allowing easier molseration. The bag ring 3004 is not limited to having the cross section of FIG. 137C, and any cross section that allows the bag to be rolled around the bag ring is within the scope of the present invention. Because the bag ring 3004 is both flexible, it can be crushed and compressed into an elongated shape for insertion and removal through a small incision or body opening. The elastic bag ring 3004 expands when released to assume an open mouth configuration to allow the sample 3006 to be easily positioned inside the bag 3002. The bag 3002 has an open top and a semi-rigid bag ring 3004 is attached near the top of the bag 3002 or its mouth. The bag 3002 can be deployed into the body, such as in the abdomen, via a trocar or other deployment device. The bag 3002 can be operated with a grasper. The specimen 3006 is loaded into a bag 3002, which is retrieved through a body wall 3056, such as an abdominal wall. Because the size of the specimen 3006 is large, the entire bag 3002 does not pass through a small laparoscopic incision. The semi-rigid bag ring 3004 is the only part that can face the rest of the bag remaining inside the abdominal cavity. The cross-section of the semi-rigid ring allows the bag 3002 to be shortened by the rolling method. This not only shortens the bag 3002 but also assists the retraction of the wound. The sample of tissue 3004 acts as an anchor to allow retraction of the wound opening, allowing further access to the tissue 3006 by a powered or manual molseration device. Once the bag 3002 is in place, the molars can be initiated. As the size of the tissue sample 3006 decreases, the semi-rigid bag ring 3004 can be further rolled to bring the tissue 3006 closer to the surface to allow easier access for molseration. Once sufficient tissue 3006 has been removed, the bag 3002 can then be withdrawn from the patient. FIG. 138C shows tissue guard 200 ready to be inserted into a body opening and into bag 3002.

  Referring to FIGS. 139A-C, the bag 3002 is connected to a delivery shaft 3038 configured to open and close the mouth of the bag 3002. Delivery shaft 3038 is advantageously used to sculpt sample 3006 when in the open mouth configuration. Delivery shaft 3038 is operated to close the mouth of bag 3002 after sample 3006 is captured, bringing bag ring 3004 through the body opening to the surface for moleserration and removal of sample 3006. The bag 3002 has an open top and a semi-rigid bag ring 3004 is attached to the top. The bag 3002 is attached to a bifurcated fork shaped shaft 3038. The fork is made of a semi-rigid material such as spring steel. The purpose of delivery shaft 3038 is to allow the bag to be operated with greater accuracy and ease. The system can be deployed in the abdomen via trocar cannula 3044. The specimen 3006 is loaded into the bag 3002 and the bag 3002 is withdrawn through the abdominal body wall 3056. To retrieve the bag 3002, the forked shaft 3038 is pulled through the trocar cannula 3044 until the corners of the bag 3002 enter the distal tip of the trocar cannula 3044. Once the bag 3002 engages the trocar cannula 3044, the bag 3002 can be pulled up to the surface through the wound opening. The entire bag 3002 never passes through. The only part that can come up to the surface is the semi-rigid bag ring 3004. Once at the surface, the forked shaft 2038 can be removed from the semi-rigid bag ring 3004. The cross section of the semi-rigid bag ring 3004 allows the bag 3002 to be shortened by the rolling method. This not only shortens the bag 3002 but also assists the retraction of the wound. The tissue sample 3006 acts as an anchor to allow retraction of the wound opening, allowing further access to the tissue 3006 by the morcellation device. Once the bag 3002 is in place, the molars can be initiated. As the size of the tissue sample 3006 decreases, the semi-rigid bag ring 3004 is further rolled to bring the tissue 3006 closer to the surface, allowing easier access by the morcellation device and blade. Once sufficient tissue 3006 has been removed, the bag 3002 can then be withdrawn from the patient. In an alternative arrangement, the bag 3002 is provided with a second bag ring 3040. The second bag ring 3040 is attached to the bag 3002 when it is lowered to approximately the middle distance of the bag 3002. This second bag ring 3040 acts as an anchor that allows the bag 3002 to be shortened while retracting the wound to its largest possible opening. The bag 3002 is attached to a bifurcated fork shaped delivery shaft 3038. The fork is semi-rigid. Because the second bag ring 3004 is external to the patient, the first bag ring 3004 is rolled / flip around itself. The cross section of the semi-rigid bag ring 3004 allows the bag 3002 to be shortened by the rolling method. This not only shortens the bag 3002 but also assists the retraction of the wound. The second bag ring 3040, down to the middle of the bag 3002, acts as an anchor that allows maximum retraction of the wound opening. This allows for additional access to the tissue 3006 by various morsation devices. Once the bag 3002 is in place, the molars can be initiated. Once sufficient tissue 3006 has been removed, the bag 3002 can then be withdrawn from the patient.

  Referring now to FIGS. 140A-B and 141A-D, another variation of a bag 3002 according to the present invention is shown. The bag 3002 includes side walls defining an inner side and a mouth. A first bag ring 3004 and a second bag ring 3040 are provided. A second bag ring 3040 is spaced distally from the first bag 3004 and interconnected by sidewalls. The bag 3002 includes a balloon 3042 disposed at the bottom of the bag 3002. The balloon 3042 forms at least part of the base of the bag and has a deflated and inflated state. The inside of the balloon 3042 is interconnected with an inflation pressure source that provides positive pressure to the balloon 3042. The inflation pressure source can also provide negative pressure to remove inflation fluid and deflate the balloon 3042, as desired by the user. The inflation pressure source is started manually or automatically by the user. The balloon 3042 at the base of the bag 3002 is spaced distally from the second bag ring 3040 as shown in FIG. 140A. FIG. 141A shows the bag 3002 inserted into the body through the body wall 3056, pulling the first bag ring 3004 out of the body to provide access to the inside of the bag 3002, The sample 3006 disposed therein can be extracted from the bag 3002. FIG. 141B illustrates pulling the proximal end and the mouth of the bag 3002 until the second bag ring 3040 substantially engages the lower surface of the body wall 3056. FIG. 141C shows the first bag ring 3004 rolled around itself and the side walls of the bag 3002 wrapped around the first bag ring 3004. As the first bag ring 3004 rolls, the length of the sidewall located between the first bag ring 3004 and the second bag ring 3040 decreases. Such a reduction in side wall length brings the specimens located within the base of the bag 3002 and within the bag 3002 closer to the body surface opening. FIG. 141D shows the balloon 3042 in an inflated state, which raises the specimen 3006 closer to the opening for easy visualization, molaration, and removal. The balloon 3042 advantageously provides an additional protective interface or barrier between the inside and the outside of the bag 3002. For example, if a morseling instrument such as a scalpel, a powered morcellator or grasper accidentally breaks the proximal end of the balloon 3042 facing the inside of the bag 3002, the balloon 3042 will contract but the bag The overall integrity of the bag 3002 is not violated, as the containment barrier to the outside or sidewalls of the bag remains intact. In essence, the balloon 3042 provides a double wall that provides additional protection at the base location where it is likely to encounter sharp instruments in the course of the morcellation. The expandable base of the bag 3002 also provides a pedestal effect on the tissue specimen 3006 even if the tissue 3006 is not centered over the balloon 3042. Also, the inflatable base of the bag provides a moat-like location such that body fluid such as blood is drained from the specimen 3006 when in the inflated state. When inflated, the inner side wall of the balloon 3042 is spaced very far from the outer side wall in the double wall arrangement of the base, whereby the outer side wall is safely distanced away from hitting the device, and on the inner side wall If there is a break, the possibility of being kept as it is increases. The double-walled side wall can be used throughout the bag 3002 as well as at the base location. The tearing of the balloon 3042 and the consequent contraction of the balloon provide visual indication to the user that a sharp instrument has hit the balloon and to further secure the outer wall when continuing extraction. Warn the user to pay attention. This is in contrast to the single wall configuration where sidewall tearing means tearing the outside of the bag 3002 without warning. After the specimen 3006 is pulled to the surface, the specimen 3006 can be easily visually observed from the outside of the body through the mouth of the bag 3002, and the molaration can be more easily advanced. The balloon 3042 can be any inflatable member and can be integrated into the floor of the bag 3004. As the molaration is performed, the size of the tissue decreases. This can cause the specimen to be lost in the bag 3002, making it difficult for the morcellator and instrument to find. By inflating the balloon 3042, the tissue 3006 can be lifted closer to the end of the morcellator and instrument, making access to the tissue sample 3006 easier.

  Referring now to FIGS. 142A-C and 143A-D, another variation of a storage bag 3002 having inflatable side walls is shown. The bag 3002 has a mouth, i.e., a side wall formed to have an open top that serves as an entrance into the interior of the bag 3002. The bag 3002 includes a first semi-rigid bag ring 3004 mounted at the top near the opening. In addition, there is also a second bag ring 3040 mounted down approximately the middle distance of the bag 3002. The second bag ring 3040 acts as an anchor shortening the bag 3002 and retracts the wound to its largest possible opening. The bag 3002 utilizes an air channel 3008 to help expand the lower portion of the bag 3002 containing the specimen. By expanding the lower part, the visibility of the sample from the upper side is greatly enhanced. This also assists in the speed at which the morsation can be performed. The bag 3002 is attached to a bifurcated fork shaped delivery shaft 3028. The fork is semi-rigid. The purpose of the delivery shaft 3028 is to allow the bag to be operated with greater accuracy and ease. The system can be deployed across the body wall 3056 and into the abdomen or other location or orifice of the body. The tissue sample 3006 is loaded into a bag 3002 and the bag 3002 is withdrawn through the abdominal body wall. To retrieve the bag 3002, the forked shaft 3028 is pulled through the trocar until the corners of the bag 3002 are in the trocar. Once the bag 3002 is engaged with the trocar, the bag can be pulled up to the surface as shown in FIG. 143A. Once at the surface, the forked shaft can be removed from the semi-rigid bag ring 3004. The entire bag 3002 never passes through. It is possible for the semi-rigid first bag ring 3004 and part of the side wall to come out to the surface. The cross-section of the semi-rigid bag ring 3004 allows the bag 3002 to be shortened by the rolling method indicated by the arrows in FIG. 143C. This not only shortens the bag 3002, but also assists the retraction of the wound, as shown in FIG. 143C. The second bag ring 3040, down to the middle of the bag 3002, acts as an anchor that allows maximum retraction of the wound opening. This allows for additional access to the tissue 3006 by the molaration instrument. The bag 3002 performs both storage and retraction functions. Once the wound is retracted, the air channel 3008 can be expanded as shown in FIG. 143D, and an optional tissue guard 200 can be used. The air channel 3008 extends outwardly creating free space around the tissue 3006. This allows more tissue 3006 to be present in free space. By being in more free space, tissue 3006 can tumble and move as it is being morsulated. Once the bag 3002 is in place, the molars can be initiated. Once sufficient tissue 3006 has been removed, the bag 3002 can then be withdrawn from the patient. In an alternative variation, the base of the bag 3002 may also be inflatable as described with respect to FIGS. 140-141.

  Referring now to FIGS. 144A-144C and 145-145D, another variation of a storage bag 3002 having inflatable sidewalls is shown without the second bag ring 3040 and with only the first bag ring 3004. It is done. The bag 3002 has an open top and a semi-rigid first bag ring 3004 attached to the top. The bag 3002 utilizes an air channel 3008 to expand the lower portion of the bag 3002 containing the specimen 3006 To help. Air channels 3008 are circumferentially disposed about the periphery of the bag in the lower portion of the bag. The air channels 3006 are interconnected and connectable to an expansion pressure source. The positive inflation pressure expands the channel and the negative pressure acts to actively contract the channel 3008. The contracted configuration is shown in FIG. 145A and the expanded configuration is shown in FIGS. 145B-D. In one variation, the air channel, which is the closest air channel closest to the opening of the bag, is annular and larger than the other air channels. The air channel 3008 is a tubular ring shaped lumen and can be fluidly connected with one or more adjacent tubular ring shaped lumens and configured to be connectable with an inflation fluid source . The lumen of this proximal first annular ring-shaped air channel exerts a reaction force on the underside of the abdominal wall, allowing greater retraction when the upper bag ring 3004 is rolled down to cause retraction. . Thus, the first annular ring shaped lumen acts similar to the second bag ring 3040 of the previous variation. Also, by expanding the lower portion, the visibility of the sample 3006 from the upper side is greatly enhanced. This also aids the speed at which the morsation can be performed. The bag 3002 is attached to a bifurcated fork shaped delivery shaft 3038. The fork is semi-rigid. The purpose of delivery shaft 3038 is to allow the bag to be operated with greater accuracy and ease. The system can be deployed into the abdomen through the trocar. The specimen 3006 is loaded into the bag 3002, and the bag 3002 is recovered through the abdominal body wall. To retrieve the bag 3002, the forked shaft is pulled through the trocar until the corners of the bag are in the trocar. Once the bag 3002 engages the trocar, the bag can be pulled up to the surface. The entire bag never passes through. Only the semi-rigid bag ring 3004 and a portion of the bag sidewall can come out to the surface as shown in FIGS. 145A-D. Once at the surface, the forked shaft can be removed from the semi-rigid bag ring 3004. The cross-section of the semi-rigid bag ring 3004 allows the bag 3002 to be shortened by the rolling method indicated by the arrows in FIG. 145D. This rolling action not only shortens the bag 3002 by rolling up the side walls of the bag, but also assists the retraction of the wound. The bag 3002 is then inflated. The bag 3002 can also be inflated prior to rolling, as shown in the figure. The first annular air channel 3008, down to the middle of the bag, acts as an anchor that allows maximum retraction of the wound opening. This allows for further access to the tissue by the morcellator. The air channel 3008 extends outwardly creating free space around the tissue 3006. This allows more tissue 3006 to be present in free space. By being in more free space, tissue 3006 can tumble and move as it is being morsulated. Once the bag 3002 is in place, the molars can be initiated. Once sufficient tissue 3006 has been removed, the bag 3002 can then be withdrawn from the patient. In an alternative variation, the base of the bag 3002 may also be inflatable as described with respect to FIGS. 140-141.

  Many different types of materials can be used for the bag and the semi-rigid ring. It may be desirable to use multiple materials, such as hybrids of polymers and woven textiles, in the same bag. The semi-rigid ring can be made of a number of flexible polymeric materials including, but not limited to, pelletane, silicone, KRATON polymers, IROGRAN polyester based thermoplastic polyurethanes, metals, polymers, plastics, rubber and the like.

  Any of the storage bags described in the present invention, including the inflatable bag 3002, may be placed in the bag 3002 to protect the bag sidewalls and adjacent tissue edges from sharp manual or powered devices. Can be used with a configured guard or shield. Additional examples of guards are shown in FIGS. 146-148. 146A-B show a cylindrical rigid guard 3047 having a cylindrical proximal end 3048 and an outwardly flared funnel shaped distal end 3050. FIG. Funnel guard 3047 acts to concentrate or collect tissue towards the cutting blade. The central lumen of the guard 3047 expands distally. The funnel shape also assists in spreading the side walls of the bag 3002 apart, providing clearance for molsulation and preventing the sample bag from engaging the blade. The guard 3047 can also include a spring loaded guard feature that prevents the blade from being exposed unless it engages tissue. This makes the handling of the molser safer. The guard of the blade can be adapted to operate with the spring loaded guard.

  Referring to FIGS. 148A-148B, the guard 3047 has an inverted funnel or lead-in guard at the distal end, with the central lumen decreasing towards the distal end 3050. Lead-in guard 3047 allows for easier coring of tissue 3006. The blade guard 3047 is conical in shape and the narrow end 3050 points in the same direction as the leading edge of the morseling tool blade. Guard 3047 pushes surrounding tissue far and aside once the blade engages tissue 3006.

  Referring now to FIGS. 147A-147B, another variation of the guard 3047 is shown including anti-rotation studs 3052 extending from the inner surface of the guard 3047 into the central lumen. The inwardly projecting anti-rotation studs 3052 prevent the lumped mass tissue 3006 from being caught by the rotating blade and rotating tube and spinning together when a powered molserator is used Hold on. When the tissue 3006 spins with the blade, there will be no relative blade motion, so the tissue is not cut. The anti-rotation stud 3052 can also be located outwardly of the guard 3052 and extend outwardly from the outer surface of the guard 3047. These protrusions block the rotation of the guard 3047. The internal anti-rotation studs 3052 also help guide and guide the tissue 3006. The studs 3052 can have various shapes and sizes. This feature can be adapted to work with any guard. In another variation, bipolar vertical tissue separators can be included in the guard. Bipolar vertical tissue separator features function to tear away the core of tissue from a cluster of masses. This alleviates the problem of coring and the inability to separate the core which has been morsified from large chunks. This feature can be adapted to work with any blade guard. Also, the light can be included in the guard 3047 and integrally formed. The purpose of light sources such as LEDs is to enhance and improve the visibility inside tissue bag 3002 for better scope visibility. This feature can be adapted to work with all blade guards. The variation of FIGS. 147A-147B further includes a plurality of holes 3054 extending across the guard 3047. These holes 3054 are configured to prevent the bag 3002 from being drawn into the blade when vacuum is used to pull the tissue 3006 out of the bag 3002, as in the case of using a vacuum powered molarator system. It plays a role of vacuum bypass hole 3054. This is achieved by keeping radial holes 3054 always exposed around guard 3047. Once the tissue engages the blade, the vacuum bypass holes do not affect the vacuum interface with the tissue. This feature can be adapted to work with any blade guard used under vacuum.

  The molaration is performed manually by the surgeon using a scalpel or electrosurgical instrument. Instead of utilizing a powered molarator, any of the bags described herein can be used with manual molaration. The bag is inserted into the body cavity through the incision. Place the target tissue into the bag and pull the opening of the bag through the incision. A bag guard as described herein is inserted into the bag, held close to the bag opening, optionally connected to the proximal end of the bag, so that the bag opening is held in the open position Make it The surgeon grasps the tissue with a grasper and pulls it towards the opening into the position of the guard. The surgeon then cuts the tissue into smaller pieces and withdraws from the body, using a scalpel instead of a powered morcellator. The cutting is performed at the position of the guard and / or against the guard so that the bag is not accidentally perforated by the scalpel. A bag containing a small piece of tissue or no tissue is removed from the body cavity with the bag guard.

  The system includes a specimen collection receptacle bag 3002 mounted on a shaft. The bag 3002 can be deployed inside the body and can capture the desired tissue 3006 after it has been exfoliated. Once the specimen 3006 is placed inside the bag 3002, there is a semi-rigid ring 3004 attached to the bag opening that can be pulled out of the body through the laparoscopic wound, incision, opening, orifice access site. is there. After the bag opening ring 3004 is pulled out of the patient, the lower bag portion remaining in the body cavity containing the specimen 3006 includes air channels 3008, which are inflated to counter internal abufflation pressure. This creates a structure that provides an internal mooring mechanism for the bag 3002. The outer bag opening ring 3004 can then be rolled down to retract the wound opening in the same manner as described above. The expanded portion of the bag 3002 remaining inside the body cavity, in which the sample 3006 is contained, is exposed to the surface here. Once the sample bag 3002 is retracted into position, a morcellator device 3000 with a central hollow spinning blade tube 3010 is attached to the bag opening ring. The morcellator 3000 is locked in the rest position and the blade tube 3010 is inserted downward through the wound and into the lower region of the bag 3002 where the specimen 3006 is located. At that time, turn on the morcellator 3000 and rotate the blade tube 3010. Once the tube 3010 is rotated, inserting the support wedge 3012 through the hollow blade tube 3010 to grasp the tissue and pull it up into the spinning blade 3010, thereby removing the large specimen 3006 through the small laparoscopic wound site Can be reduced to smaller core pieces. The morcellator 3000 also includes a camera 3014 at the distal end of the morcellator 3000 for visualization inside the analyte bag 3002. Once the tissue 3006 is completely removed or reduced in size to be drawn sufficiently for withdrawal through the wound site, the morcellator 3000 is removed from the bag ring, the bag 3002 is contracted and finally the bag 3002 is laparoscopically wounded Pull out through to complete the procedure.

  Referring now to FIG. 149, a system is shown that includes a powered morserator 4000 and a bag 4002 connected to the side of the morserator shaft 4004. With additional reference to FIGS. 150A-D, the morcellator 4000 includes a handle 4006 connected to a shaft 4004, with one or more blades 4008 at the distal end of the shaft 4004. Morcellator 4000 further includes a motor 4010 disposed on handle 4006. Motor 4010 is configured to be connected to and rotate gear pinion 4012. Gear pinion 4012 is further connected to a gear train including a gear inner tube 4012 and a gear outer tube 4016. The gear outer tube 4016 is further connected to a spacer 4018, which in turn is connected to the outer shaft 4020. The distal end of the outer shaft 4020 is connected to the blade 4008. The gear inner tube 4014 is connected to the inner shaft 4026, which in turn is connected to the second blade 4022. Gear outer tube 4016 and gear inner tube 4014 rotate in opposite directions and are configured to create a counter-rotating blade at the distal end. Because it is a double inverted tube, there are two tubes. One tube is inside the other. The inner tube rotates in one direction and the outer tube rotates in the opposite direction. In one variation, the blades are attached to the end of the outer tube. The concept of counter-rotating tubes is to double the relative velocity experienced by the tissue when compared from the point of view of the blade. All tube configurations can have the outermost tube holding the blade guard configuration. In another variation, the inner tube is stationary relative to the rotating outer tube. The outer tube has a blade attached at its end and is rotatable. The concept of a stationary inner tube is to create a smooth member that allows tissue to more easily go up the working channel. In another variation, a single outer tube rotates and there is only one tube with a blade attached at its end. The inside of the tube is featureless and smooth. In another variation there are three tubes, the inner and outer tubes are stationary and the middle tube is rotated. The blades are attached to the end of the intermediate rotary tube and project beyond the inner and outer tubes. The stationary outer tube is for protection against being rubbed by the rotating intermediate tube. The stationary inner tube is to facilitate tissue going up the tube more easily. In another variation, a riffled tissue advancement tube is provided in a configuration for any tube that is a rotating tube and has on its inner surface a back contact with non-occluded tissue. A Rifle-like pattern is formed on the inner surface of the rotating tube, which exerts an axial force on the morseled tissue causing it to fly away from the blade. In yet another variation, an auger type tissue advancement tube is provided in any rotating inner tube configuration. The tube has a plurality of flutes that move the length inside the tube. The end of the groove grips the tissue causing it to run up in a direction away from the blade. As can be seen in FIG. 150C, counter-rotating tubes 4020, 4026 are driven from a single gear 4012, and as shown in FIG. 150B, an overmolded seal or quad ring seal Provide 4046 and seal them. The entire electric motor is enclosed within the handle 4006 and may be powered by a battery or connected to an external power source.

  The spring loaded blade guard 4024 operates to cover or uncover the blades 4008, 4022 and the trigger 4028 operates to start the motor 4010. The spring loaded blade guard 4024 operates to allow the blade 4008 to be exposed only when the tissue contacts the end of the blade guard for additional safety. The blade guard 4024 shaft with the opening and the proximal knob can be removed, and the blade guard may be non-rotational. The inner and outer shafts 4026, 4020 are coaxial and define a working channel 4030 in the middle. At the proximal end, a conical funnel 4032 is provided to facilitate the insertion of instruments such as graspers into the working channel 4030. The proximal end of the morcellator 4000 may also be adapted to connect with the analyte receptacle 4034 shown in FIG. 151, and a vacuum source, for extraction of the morcellation analyte. The sample receptacle 4034 is a transparent container, including an inlet port 4038 and a port 4040 for connecting to a vacuum source, disposed on the removable lid. The port 4040 connected to the vacuum source can include a valve to turn the vacuum on and off and can be configured to operate electronically. The proximal end of morcellator 4000 can also be adapted to connect with seal assembly 4042 as shown in FIG. 150D. The seal assembly 4042 can include a zero seal and a septum seal for sealing against the instrument inserted into the opening at the proximal end of the seal assembly 4042. Seal assembly 4042 can further include a port 4044 for connecting to a fluid source under pressure. The blade guard 4024 includes at least one side slot or side window opening 4036 configured to expose the blade through the side, and the tissue to be morsulated through the side of the molarator 4000 into the working channel 4030 To accept. The blade guard 4024 can be rotated or retracted to cover and close the side opening, or the distal opening to receive tissue to be morsulated at the distal end opening into the working channel 4030 The blade can be exposed at the part.

  Referring now to FIG. 152, a bag 4002 configured to be attached to a morselator shaft 4004 having side openings 4036 is now described. In one variation of the bag 4002, the bag 4002 has an open top 4048 with means 4050 for closing. The morselator shaft 4004 has rounded ends and is adapted to connect with the bag 4002. The side of morcellator shaft 4004 has a windowed opening 4036. The sample collection system is inserted into the body, for example via a trocar or via an open wound or body orifice. The bag 4002 is then opened and the tissue sample is placed in the bag 4002. The bag 4002 is then sealed by the closure means 4050. A morserator shaft 4004 can be attached to the morserator 4000 to initiate molseration. Alternatively, a bag tube 4066 is provided, and the morserator 4000 is easily attached to the bag tube 4066 by sliding the morselator shaft 4004 into the bag tube 4066 as shown in FIGS. The bag 4002 can be pre-attached to the bag tube 4066. Once the sample is reduced, the sample collection system is withdrawn from the patient. Examples of morcellators are filed on April 14, 2008 and October 24, 2012, respectively, and are incorporated herein by reference as if fully described, US Patent Application Nos. 12 / 102,719 and 13/659. , 462.

  Referring now to FIGS. 153-157, various bag closing means are described. In FIGS. 153A-153B, a drawstring 4052 located at the top of the bag 4048 is used to close the open top 4048. In FIGS. 154A-154B, a zip lock or zipper type 4054 closure is provided which can be used to lock and unlock the two sides of the closure with a slider to open and close the top 4048. In Figures 155A-C, another closure means includes a grommet 4056 formed near the bag top 4048 of the bag 4002. Insert a grasper 4058 or other device into the opening of grommet 4056 and then twist down as shown in FIG. 155C to roll down bag 4002 and close open top 4048. In FIGS. 156A-156B, the top 4048 is provided with hook and loop fasteners 4060. Contact both sides of the hook and loop fasteners and close the open bag top 4048. In FIGS. 157A-157B, the bag top 4048 includes a plurality of grommet openings 4062. Specifically, four openings are provided. Use an instrument such as a grasper 4058 to grasp all of the openings 4062 and then twist and roll open the open as shown in FIG. 157B.

  As shown in FIGS. 158A-158E, a plastic guard 4064 is provided to protect the bag 4002 and to prevent the bag from entering the side slot 4036 on the morcerator shaft 4004 and coming into contact with the rotating blade 4008. Provided. Plastic guard 4064 is formed of a one-piece semi-rigid plastic and is configured to fold and insert into morcellator slot 4036. The plastic guard 4064 is formed of a harder material than the bag 4002 and surrounds the side opening 4036 and provides a through-like or funnel-like opening to unroll the bag 4000 to open the opening 4036 It is configured to be separated from. Bag 4002 is attached to the distal end of morcellator shaft 4004. The bag 4002 has an open top 4048 with closure means 4050. The bag 4002 also has a semi-rigid structure at the side opening 4036 of the morcellator shaft 4004 to allow tissue to be loaded into the bag 4002 more easily. The analyte collection system is introduced into the body via a trocar or open wound or orifice or other delivery mechanism. The bag 4002 is then opened and the tissue sample is placed in the bag 4002. The bag 4002 is then sealed via the closure means 4050. A morcellator 4000 is attached to the proximal end of the morcellator shaft 4004 to start molseration. Alternatively, a bag tube 4066 is provided and the morserator 4000 is easily attached to the bag tube 4066 by sliding the morselator shaft 4004 into the bag tube 4066 as shown in FIG. The bag 4002 can be pre-attached to the bag tube 4066 with or without the plastic guard 4064 or a stiffened stiffened portion near the distal end opening of the bag tube 4066. The morselator shaft 4004 and the bag tube 4066 are held together frictionally via a knob attached to the bag tube 4066. The knob interfaces with the morcellator handle by snap or friction fit engagement. Once the sample is reduced, the sample collection system is withdrawn from the patient. The semi-rigid structure of the guard 4064 can be made of spring steel, nitinol or molded plastic. All three variations of the material allow closure of the bag 4002 by using the drawstring method or by pinching the ends and rolling the structure to close the bag 4002. In another variation shown in FIG. 160, a bag 4002 is attached to the bag tube 4066. The bag 4002 has a closed end. The opening 4068 of the bag 4002 is on the side of the bag 4002. The bag 4002 also has a semi-rigid structure at the opening to allow tissue to be more easily loaded into the bag. Bag tube 4066 has a rounded end. The side of the bag tube 4066 has a windowed opening 4070. The sample collection system is inserted into the abdomen through the trocar or an open wound. The bag 4002 is then opened and a tissue sample is placed in the bag 4002. The bag 4002 is then sealed and fitted with a morcellator 4000 to start the molaration. Once the sample is reduced, the sample collection system is withdrawn from the patient. Side opening 4068 can include a reinforcement of spring steel, nitinol or molded plastic disposed in the middle of the side wall of bag 4002. The side openings 4068 spring open and oval to facilitate easier specimen insertion into the bag 4002. All three variations of the material may close the bag by using the drawstring method or by pinching the ends and rolling the structure to close the bag 4002. In another variation, spring steel, nitinol or molded plastic is placed near the bag tube 1066 as shown in FIG.

  In another variation shown in FIGS. 162A-162C, the bag 4002 is a separate component from the bag tube 4066. The bag 4002 has two open ends 4072, 4074. One opening 4072 is larger than the other. The larger end 4072 is semi-rigid from spring steel, nitinol or a plastic member. Different closure means 4050, such as drawstring 4052 or a method of rolling down across can be used to seal the larger end 4072 of the bag 4002. The smaller end 4074 has a spring steel or nitinol clamp attached to the bag tube 4066. A clamp 4076 is mounted around the rigid blade guard 4064. The taper of rigid blade guard 4064 helps clamp 4076 to sit on the rim and slip off bag tube 4066. Bag tube 4066 has a rounded end. The side of the bag tube 4066 has a windowed opening 4070. The bag 4002 is initially introduced into the abdominal body through an opening, orifice, or open wound through a trocar, delivery shaft, instrument or other deployment method. The large end 4072 of the bag is then opened and placed around the tissue sample 4078. The larger end 4072 of the bag 4002 is then sealed. The bag tube 4066 is then introduced into the body. Bag 4002 is then attached to bag tube 4066 using clamp 4076. A morcellator 4000 is attached and starts the molaration. Once the specimen 4078 is reduced, the specimen collection system is withdrawn from the patient.

  In another variation shown in FIGS. 163A-163C, the bag 4002 is attached to a bag tube 4066 named bag tube. The bag 4002 has an open end. Bag tube 4066 has a rounded end. Bag tube 4066 has an over sheath. The sheath tip has two holes to facilitate the opening and closing of the semi-rigid bag opening 4068 with nitinol or other flexible semi-rigid drawstrings 4052. The sheath also has two channels parallel to the axis of the tube to facilitate the recovery of nitinol. The side of the tube has a windowed portion 4070. The analyte collection system is introduced into the body through the opening as shown in FIG. 163B. The bag 4002 is then opened by deploying a drawstring 4052, and the specimen 4078 is recovered by surrounding the tissue specimen 4078 with the net formed by nitinol and the bag 4002. This can be done with or without the assistance of graspers or dissectors. Once tissue 4078 is enclosed, nitinol can be collected proximally via drawstring 4052, thereby closing bag 4002 around tissue sample 4078 and sealing bag 4002. A morcellator is attached and starts the molaration. Once the sample is reduced, the sample collection system is withdrawn from the patient.

  In another variation, the bag 4002 has an open top with a semi-rigid ring attached to the top. The bag 4002 can be rolled tightly and then deployed into the abdomen via the trocar. The bag 4002 can then be opened internally by manipulation with a grasper. Specimen 4078 is loaded into bag 4002 and bag 4002 is withdrawn through the abdominal wall. The entire bag 4002 never passes through. It is only the semi-rigid ring that can come out to the surface. It is possible to start the molars. Once the tissue 4078 is sufficiently removed, the bag 4002 can then be withdrawn from the patient.

  The tissue guards described herein are typically used with storage bags. The bag is placed inside the body through the body opening. The body opening points to any entrance into the patient and can include, but is not limited to, an incision site and a natural orifice. The target analyte is typically too large to be safely removed through the body opening, and manipulations such as cutting with a blade are required to extract the target analyte through the body opening. A minimally invasive, laparoscopic body opening is usually smaller than the size of the target analyte. Place the target specimen inside the bag and pull the bag's mouth out of the patient. The guard is placed inside the mouth of the bag and anchored across the body opening to draw the target analyte into the lumen of the guard. While in the lumen of the guard, the target analyte is in a protected molaration zone where the surgeon can reach and cut the target analyte using a blade for extraction. The guard protects against the vagus blade and also provides a direct cutting surface that can be placed to shrink tissue. The total length of the guard typically defines the length of the molaration zone which protects the bag and the tissue at the edge of the body opening. In addition, retractors can be used. The retractor can be integrally formed with the bag or can be a separate stand-alone device. The typical retractor described herein is a two ring retractor where the flexible sidewall material is located between two rings. The sidewalls of the retractor can be rolled around the first ring and configured to allow tissue retraction at the edge of the body opening. If a retractor is used, it can be placed inside the bag between the marginal tissue and the bag or between the bag and the guard. The above description describes various variations of guards, bags and retractors used in manual molars. In the power mode, the guard is inserted into the interior of the bag and the moles are performed. In another variation of powered molaration, a stability cap is connected to the proximal end of the proximal ring or guard of the bag, and powered molaration is performed. The stability cap ensures that the longitudinal position of the blade does not extend beyond the predetermined molaration zone inside the guard, or to ensure that the distal end of the guard is beyond a safe short distance. Play a role in deciding. In another variation of powered molaration, a retractor is used, in which case the retractor is placed between the marginal tissue and the bag or between the bag and the guard, as described above, and the molaration is performed Be done. In the previous variation, the stability cap can be used to connect with the proximal ring of the retractor, the proximal ring of the bag, or the proximal end of the guard, and the molaring is performed. When performing procedures such as hysterectomy, in addition to the variations described above, any one of the following techniques may be used in conjunction with any one of the variations described above. In one variation, the bag is placed through the vagina and the target specimen (eg, uterus) is placed inside the bag while the bag is inside the body cavity, then the mouth of the bag is pulled through the abdominal incision where the guard is Insertion into the mouth of the bag, morsation, extraction, and removal of the bag take place at the abdominal opening. In another variation, the bag is placed through the vagina and the target specimen (eg, uterus) is placed inside the bag while the bag is inside the body cavity, then the mouth of the bag is pulled back through the vaginal canal, where the guard is placed in the bag Inserted into the mouth of the mouth, molsulation, extraction and removal of the bag takes place in the vagina. In yet another variation, the bag is placed through the abdominal incision and a target specimen (eg, uterus) is placed inside the bag while the bag is inside the body cavity, then the bag's mouth is pulled through the vaginal canal, where A guard is inserted into the mouth of the bag, and morcellation, extraction and removal of the bag take place in the vagina. In one other variation, the bag is placed through the abdominal incision, the target specimen (eg, uterus) is placed inside the bag while the bag is inside the body cavity, and then the mouth of the bag is pulled back through the abdominal incision, The guard is now inserted into the mouth of the bag and the molars, extraction and removal of the bag take place in the vagina. In an alternative approach to molaration of the uterus or other target analytes, the bag can be omitted. In such a case, make an incision in the abdominal wall, place the guard across the incision in the abdomen, strip the uterus or other target specimen, pull it through the central lumen of the guard, and go through the abdominal incision It takes place in the department. Alternatively, the target sample (e.g., uterus) is approached through the vagina, the guard is placed inside the vaginal canal, the target sample is ablated, drawn through the central lumen of the guard, and molaration and extraction are performed vaginally. As yet another variation of the bag-free abdominal approach, the procedure can be observed through a laparoscope inserted through the vagina. As a further variation of the vaginal approach without the bag, the procedure can be observed via a laparoscope inserted through the abdominal incision.

  In some cases, guards are not used. In one such variation that does not use a guard, the bag is placed inside the body cavity via the vaginal canal, the target analyte is placed inside the bag, the mouth of the bag is pulled through the abdominal incision, the retractor is Can be placed inside the bag transversely, and morcellation, extraction, and removal of the bag can be performed at the abdominal incision. In another variation that does not use a guard, the bag is placed inside the body cavity via the vaginal canal, the target analyte is placed inside the bag, the mouth of the bag is pulled back through the vaginal canal, and the retractor is inside the bag inside the vaginal canal It can be placed on the vagina, and the molaring, extraction and removal of the bag takes place in the vagina. In another variation that does not use a guard, the bag is placed through the abdominal incision into the body cavity, the target analyte is placed inside the bag, the mouth of the bag is pulled through the vaginal canal, and the retractor is inside the vaginal canal inside It can be placed on the vagina, and the molaring, extraction and removal of the bag takes place in the vagina. In another variation that does not use a guard, the bag is placed into the body cavity via the abdominal incision, the target specimen is placed inside the bag, the mouth of the bag is pulled through the abdominal incision, and the retractor is the bag inside the vaginal canal It can be placed internally, and the molars, excision and removal of the bag take place at the abdominal incision. In any of the variants that use a retractor without a guard, it is preferable to use any of the cut resistant retractors described above. Also, in any of the variations that use a retractor without a guard, the retractor can be placed between the bag and the tissue edge. It is also preferred to use any of the cut resistant bags described above, in variations that either use or do not use the retractor without a guard. Power conversion can also be used with any method that uses a guard. In such cases, a stability cap is used and connected to the proximal end of the bag or the proximal ring of the reactor.

  In a variation that uses a retractor without a guard, a cut resistant retractor is provided. The retractor has a first ring and a compressible second ring interconnected by webbing or sidewalls. The retractor is configured to roll up the webbing around the first ring to reduce the length of the retractor and retract the tissue edge. The bottom ring is inserted through the body opening and resides inside the patient, while the top ring of the retractor is above the patient. The upper ring is rolled / flip on itself as well as the bag, pulling the lower ring of the retractor closer and bringing the side walls into a taut relationship between the rings. The lower ring of the retractor advantageously retracts a portion of the bag inside the patient away from potential damage that may be caused by puncturing and tearing from the blade. At least a portion of the webbing is made of a puncture resistant cut resistant material. The retractor is inserted into the storage bag and into the body opening to retract the bag and the tissue edge, the first ring of the retractor and the mouth of the storage bag being outside the patient and the second of the retractor The ring and the rest of the storage bag are configured to reside inside the patient. This placement of the bag between the retractor and the tissue edge at the body opening anchors the bag to the patient's body. In one variation, only about 4 inches of the distal portion of the webbing length is made of KEVLAR, DYNEEMA or other cut resistant material and the proximal portion of the webbing is not made of cut resistant material, polyurethane or Made of other flexible films. This arrangement allows the proximal end of the webbing to be more easily rolled around the first ring during retraction. As the length of the webbing is reduced by rolling, the distal cut-resistant portion of the webbing advances to a position closer to the proximal end or the first ring of the retractor and to protect the molaration. With less cutting resistant material, which can be thick and bulky, the retractor is less expensive and because less cutting resistant material is rolled around the first ring, the first ring is flipped and rolled. It will be easier to do. In another variation, the entire webbing is made of a cut resistant material. In another variation, for example for use in the vagina, only the approximately 5 inch proximal portion of the length of the webbing is cut resistant made of KEVLAR, DYNEEMA or other cut resistant material, and distal to the webbing The part is not made of cut resistant material but is made of polyurethane or other flexible film for further flexibility and anchoring at the distal end. In vaginal surgical procedures such as total laparoscopic hysterectomy, the first ring at the proximal end does not have to be rolled down that much. Thus, the proximal end of the webbing is formed of the cut resistant material as compared to an abdominal surgical procedure where the webbing is rolled substantially around the first ring and the proximal end is not formed of the cut resistant material.

  According to one aspect of the present invention, there is provided a pollution control system for manual or power in-situ morcellation. The system includes a storage bag having a mouth and a shield configured to be removably inserted into the mouth of the bag. The shield has a central lumen that protects the bag and surrounding tissue as well as providing a working channel for the molaration.

  According to another aspect of the present invention, there is provided a device for safely removing a tissue sample from a body cavity through a body opening smaller than the tissue sample. The device includes a removable shield configured to be anchored to the body opening. The device further includes a bag or retractor located between the body opening and the shield.

  According to another aspect of the invention, a shield is provided having a side wall defining a central opening. The shield includes a C-shaped concave outer surface for anchoring the shield in the body opening.

  According to another aspect of the invention, a shield is provided having a side wall defining a central opening. The shield includes a C-shaped concave outer surface for anchoring the shield in the body opening. The shield is separated so that one part of the shield is nested within another part of the shield, and the shield is expanded from the reduced lateral configuration to the enlarged lateral configuration by changing the nested portion of the shield Yes, and vice versa.

  According to another aspect of the invention, an expandable shield is provided having a sidewall defining a central opening. The shield is movable between the first configuration and the second configuration. The first configuration has dimensions that are greater than the dimensions when in the second configuration, the dimensions being longitudinal and / or transverse dimensions.

  According to another aspect of the present invention, there is provided a system for preventing the possibility of spreading cancer cells when removing large tissue samples from small openings in the body. The system comprises a vessel and a molaration zone. The molaration zone is insertable into and removable from the container. The molaration zone protects the container from penetration by the molaration device.

  According to another aspect of the present invention, a shield is provided. The shield includes a blade connected to the shield. The blade is movable relative to the shield along a predetermined path, and the shield surrounds at least a portion of the predetermined path to protect tissue around the body opening.

  Referring now to FIGS. 164-167, a shield 5000 in accordance with the present invention is shown. Shield 5000 includes a band of flexible cut resistant material. The shield 5000 has an inner surface 5002 and an outer surface 5004 interconnected by a top end 5006 and a bottom end 5008 and a first end 5010 and a second end 5012. The band is configured to define a central lumen having a major axis. The central lumen has a lumen diameter perpendicular to the long axis. The lumen diameter can vary along the longitudinal axis. For example, the inner surface 5002 is shaped like a convex shape, as shown in FIGS. 164-167, where the lumen diameter is at the top or bottom end 5006 and 5008 of the center or waist of the band. Larger than lumen diameter. In one variation, the inner surface 5002 defines a constant lumen diameter from the upper end 5006 to the bottom end 5008 or defines an angled or funnel-like shape or other curvature or shape. The outer surface 5004 substantially conforms in shape to the inner surface 5002 to define a band of substantially uniform thickness, although the invention is not so limited and the outer surface 5004 has a different shape than the inner surface 5002 And / or have different band thicknesses along the major axis. The curved, funnel-like or C-like concave shape of the outer surface 5004 as described herein above anchors at the tissue edge when the shield 5000 is inserted into a body orifice, incision site or other opening. Assist. Also, the larger diameter shape at the upper end 5006 helps to provide a cutting board surface for performing manual molaration and protecting the surrounding tissue. For example, a flatter, more planar top end 5006 orientation with the inner surface 5002 facing upward and perpendicular or nearly perpendicular to the long axis and the outer surface 5004 facing downwards, eg facing the abdominal wall downward. Form a larger protective overlap or larger cutting board-like surface. As shown in the variation of FIGS. 164-167, the outer surface of the band has a concave or curved along the major axis from the top 5006 to the bottom 5008 and is also from the first 5010 It extends circumferentially around the guard to the end 5012 of the. The shield 5000 is made of a flexible resilient material such as plastic and is molded to have a stationary configuration that defines a stationary lumen diameter. The stationary configuration is illustrated in FIGS. 164-166 where a gap is defined between the first end 5010 and the second end 5012. The gap is approximately 5 to 10 degrees and has an arc length of approximately 4 to 6 mm. The static lumen diameter is approximately 40 mm at the barrel. Because the shield 5000 is elastic and flexible, its lumen diameter bends and turns the band inward to reduce the gap, and the first end 5010 of the band and the second Adjustment by overlapping the end 5012 to reduce the lumen diameter, or by bending or flexing the band outwards to increase the gap and increasing the lumen diameter relative to the static lumen diameter It is possible. Due to the increased or reduced lumen diameter relative to the resting lumen diameter, the band, due to its elastic nature, tends to spring back toward the near resting configuration and the resting lumen diameter. In one variation, the stationary configuration has no gaps. As the diameter of the band decreases, the first end 5010 overlaps the second end 5012 to form a spiral when viewed from the top or bottom. The outer surface 5004 of the band at the first end 5010 faces at least a portion of the inner surface 5002 at the second end 5012 so that the portion of the band near the first end 5010 is the second end Nest in the part of the band near 5012 In order to accommodate the first end portion of the nested band, the second end portion is separated by a distance 5014 approximately equal to the width of the band wall, ie the material between the inner surface 5002 and the outer surface 5004 Is configured to jog outwardly by approximately 1 to 3 mm, so that when the bands are nested, the inner surface 5002 is by the overlapping segments of the bands in the overlapping position. It is adapted to maintain a large internal diameter which is not reduced, so that as can be seen in FIG. 167, the inner surface is substantially flush at the intersection with the overlapping position. An inner ridge surface 5016 is formed in the shield 5000 by an outwardly extending step or irregularity in the inner surface of the band defined by the increased lumen diameter. The increased lumen diameter extends from the ridge 5016 to the second end 5012 along a portion of the circumference of the band. The inner ridge 5016 is formed approximately 127 degrees from the second end 5012. An inner ridge 5016 is formed relative to the inner surface 5002 and extends longitudinally substantially perpendicularly from the inner surface 5002 from the upper end 5006 to the bottom end 5008. The inner ridges 5016 form corresponding outer ridges 5018 when the bands are formed to create a step at the inner ridges 5016, where the bands are circumferentially from the inner ridges 5016 to the second end 5012 The inner diameter increases by segment distance 5014 by approximately 127 degrees around. Between the inner ridge 5016 and the second end 5012, at least one abutment is formed between the upper end 5006 and the bottom end 5008 extending along the longitudinal axis.

  The first inner abutment 5020 is formed on the inner surface 5002. The surface of the first inner abutment 5020 faces the second end 5012 and is substantially perpendicular to the inner surface 5002 and outwardly from the inner surface 5002 along the major axis with the upper end 5006 and the bottom It extends between the end 5008. The first inner abutment 5020 has a height from the inner surface 5002 that is approximately equal to or greater than the thickness of the band material between the inner surface 5002 and the outer surface 5004. In the first reduced configuration, when the first end 5010 overlaps the second end 5012 and the outer surface 5004 of the first end 5010 overlaps the inner surface 5002 of the second end 5012 The first end 5010 is configured to contact the first inner abutment 5020 to lock and prevent further reduction in the size of the inner diameter. This configuration serves to lock the shield 5000 in a fixed diametrical / lateral dimension, and the shield 5000 maintains a degree of overlap circumferentially around a portion of the perimeter of the shield 5000. This lock is particularly useful when the shield 5000 is placed inside a body orifice or incision where the force of the tissue tends to collapse the central lumen and further reduce the inside diameter. The central lumen acts as a working channel and locking occurs when at least a portion of the shield 5000 contacts the first inner abutment 5020. The first inner abutment 5020 is located approximately 30 degrees from the second end 5012. When the first end 5010 contacts the first inner abutment 5020, the inner diameter is approximately 36 mm.

  Shield 5000 further includes a second inner abutment 5022 at a further distance from second end 5012. Specifically, the second inner abutment 5022 is located approximately 65 degrees from the second end 5012. A second inner abutment 5022 is formed on the inner surface 5002. The surface of the second inner abutment 5022 faces the second end 5012 and is substantially perpendicular to the inner surface 5002 and outwardly from the inner surface 5002 along the major axis with the upper end 5006 and the bottom It extends between the end 5008. The second inner abutment 5022 has a height from the inner surface 5002 that is approximately equal to or greater than the thickness of the band material between the inner surface 5002 and the outer surface 5004. The first inner abutment 5020 and the second inner abutment 5022 are substantially parallel. In the reduced diameter / lateral configuration, the first end 5010 overlaps the second end 5012 and the outer surface 5004 of the first end 5010 faces the inner surface 5002 of the second end 5012. When overlapping, the first end 5010 contacts either the first inner abutment 5020 or the second inner abutment 5022 to lock and prevent further reduction in the size of the inner diameter. Configured The second inner abutment 5022, like the first inner abutment 5020, serves to lock the shield 5000 in a fixed diametrical / lateral dimension, the shield 5000 being around the periphery of the shield 5000 Maintain some overlap in the circumferential direction. This lock is particularly useful when the shield 5000 is placed inside a body orifice or incision where the force of the tissue tends to collapse the central lumen and further reduce the inside diameter. The central lumen acts as a working channel, and locking occurs when at least a portion of the shield 5000 contacts the second inner abutment 5020. When the first end 5010 contacts the second inner abutment 5022, the inner diameter is approximately 33 mm. When the first end 5010 contacts the second inner abutment 5022, the first inner abutment 5020 is positioned against the outer surface 5004. A first outer abutment 5024 or receiving area 5024 is formed on the outer surface 5004 to receive the first inner abutment 5020. In one variation as shown, the receiving area 5024 includes an abutment formed therein, and in another variation, the receiving area is not configured to have an abutment surface. The first outer abutment 5024 is located approximately 30 degrees from the first end 5010. A first outer abutment 5024 is formed on the outer surface 5004. The surface of the first outer abutment 5024 faces the first end 5010 and is substantially perpendicular to the outer surface 5004 and inwardly from the outer surface 5004 along the major axis with the upper end 5006 and the bottom It extends between the end 5008. The first outer abutment 5024 has a height from the outer surface 5004 that is approximately equal to or greater than the thickness of the band material between the inner surface 5002 and the outer surface 5004. The first outer abutment 5024 and the first inner abutment 5020 and the second inner abutment 5022 are substantially parallel. When the first end 5010 overlaps the second end 5012 and the first end 5010 contacts the second inner abutment 5022, the first inner abutment 5020 is the first outer abutment. It faces and contacts the mentament 5024 to lock and prevent further reduction of the size of the inner diameter.

  The shield 5000 further includes a third inner abutment 5026 located at a further distance from the second end 5012. Specifically, the third inner abutment 5026 is located approximately 100 degrees from the second end 5012. A third inner abutment 5026 is formed on the inner surface 5002. The surface of the third inner abutment 5026 faces the second end 5012 and is substantially perpendicular to the inner surface 5002 and outwardly from the inner surface 5002 along the major axis with the upper end 5006 and the bottom It extends between the end 5008. The third inner abutment 5026 has a height from the inner surface 5002 that is approximately equal to or greater than the thickness of the band material between the inner surface 5002 and the outer surface 5004. The first inner abutment 5020, the second inner abutment 5022, and the third inner abutment 5026 are substantially parallel and spaced approximately equally around the circumference of the inner surface 5002. In the reduced diameter / lateral configuration, the first end 5010 overlaps the second end 5012 and the outer surface 5004 of the first end 5010 faces the inner surface 5002 of the second end 5012. When overlapping, the first end 5010 contacts either the first inner abutment 5020, the second inner abutment 5022, or the third inner abutment 5026 to adjust the inner diameter variably As such, and at this time, it is configured to lock and prevent further reduction of the size of the inner diameter. The third inner abutment 5026, like the first inner abutment 5020 and the second inner abutment 5022, serves to lock the shield 5000 in a fixed diametrical / lateral dimension, the shield 5000 being , Maintain some overlap circumferentially around the perimeter of the shield 5000. This lock is particularly useful when the shield 5000 is placed inside a body orifice or incision where the force of the tissue tends to collapse the central lumen and further reduce the inside diameter. When the first end 5010 contacts the third inner abutment 5026, the inner diameter is approximately 30 mm. When the first end 5010 contacts the third inner abutment 5024, the first inner abutment 5020 and the second inner abutment 5022 are positioned against the outer surface 5004. A first outer abutment 5024 is formed on the outer surface 5004 and a second outer abutment or receiving area 5028 is formed on the outer surface 5004 to receive the first inner abutment 5020 and the second inner abutment 5022. Be done. In one variation, the receiving area is provided with an abutment surface, and in another variation, the receiving area is sized and configured to receive the inner abutment flush. The second outer abutment 5028 is located approximately 65 degrees from the first end 5010. A second outer abutment 5028 is formed on the outer surface 5004. The surface of the second outer abutment 5028 faces the first end 5010 and is substantially perpendicular to the outer surface 5004 and outwardly from the outer surface 5004 along the major axis with the upper end 5006 and the bottom It extends between the end 5008. The second outer abutment 5028 has a height from the outer surface 5004 that is approximately equal to the height of the inner abutment or the thickness of the band material between the inner surface 5002 and the outer surface 5004. The second outer abutment 5028, the first outer abutment 5024 and the first inner abutment 5020, the second inner abutment 5022 and the third inner abutment 5026 are substantially parallel. When the first end 5010 overlaps the second end 5012 so that the first end 5010 contacts the third inner abutment 5026, the first inner abutment 5020 The second outer abutment 5022 faces and is in contact with the second outer abutment 5028, faces the first outer abutment 5020 and locks it, locking the further reduction of the size of the inner diameter To prevent.

  The shield 5000 further includes a third outer abutment 5030 located at a further distance from the first end 5010 than the second outer abutment 5028. Specifically, the third outer abutment 5030 is located approximately 100 degrees from the first end 5010. The third outer abutment 5030 is formed on the outer surface 5004. The surface of the third outer abutment 5030 faces the first end 5010 and is substantially perpendicular to the outer surface 5004 and inwardly from the outer surface 5004 along the major axis with the upper end 5006 and the bottom It extends between the end 5008. The inward extension of the outer abutment forms a ramp-like surface on the inner surface 5002. The third outer abutment 5030 has a height from the outer surface 5004 that is approximately equal to or greater than the thickness of the band or inner abutment. The third outer abutment 5030 is configured to receive and receive the first inner abutment 5020 when the first end 5010 abuts the inner ridge 5016, as shown in FIG. In another variation, the first end 5010 abuts a fourth inner abutment not configured as an inner ridge 5016 as described herein. The first inner abutment 5020, the second inner abutment 5022, and the third inner abutment 5026 are substantially parallel. In the reduced diameter / lateral configuration, the first end 5010 overlaps the second end 5012 and the outer surface 5004 of the first end 5010 faces the inner surface 5002 of the second end 5012. When overlapping, the first end 5010 contacts either the first inner abutment 5020, the second inner abutment 5022, the third inner abutment 5026 or the inner ridge 5016 to change the inner diameter And is configured to lock and prevent further reduction in the size of the inner diameter at this time. In one variation, all of the inner abutments, including the inner ridges, are spaced at substantially equal distances. The first end 5010 is shown in contact with the inner ridge 5016 in FIG. 167 and constitutes a shield 5000 having a minimum relative inside diameter of approximately 28 mm. When the first end 5010 contacts the inner ridge 5016, the first inner abutment 5020, the second inner abutment 5022, and the third inner abutment 5026 are positioned against the outer surface 5004 and In particular, it is received in or against the third outer receiving area or abutment 5030, the second outer receiving area or abutment 5028, and the first outer receiving area or abutment 5024, respectively. . To unlock the shield 5000, the first end 5010, which is a segment of the shield 5000 nested inside, is moved towards the long axis to release the abutted surfaces. The first end 5010 is bounded by a marker 5032, such as a tab, a grip with a textured surface, or a contrast-colored area, for example near the top 5006 or the bottom 5008, and the user can shield 5000 Serves as an indicator to indicate which end of the to be nested within the shield 5000, so the abutment interlocks accordingly. Marker 5032 also facilitates withdrawal or release of shield 5000 from the locking configuration by providing a textured position for pulling or grasping the shield. Markers 5032 can further serve the purpose of indicating a direction to the user which side of the shield should be up when the shield is asymmetric along the longitudinal axis.

  Although the three inner abutments 5020, 5022, 5026, the three outer abutments 5024, 5028, 5030 and the one inner ridge 5016 have been described in a specific spacing and angular relationship, the invention is not limited thereto. Any number of inner abutments can be provided to provide a variable lock configuration to achieve the desired working channel inner diameter. Further, while the gap is shown as approximately 8 degrees in the relaxed configuration, the invention is not so limited and the shield 5000 may have a larger gap or a smaller gap, or even without a gap. Good. As mentioned above, the shield 5000 has an abutment, in particular one or more inner abutments 5020, 5022, 5026, when the first end 5010 variably selects and fixes the inner diameter. And / or designed to act as a functional locking edge contacting one or more inner ridges 5016. In another variation, the first end 5010 does not serve as a functional edge, but instead when the outer abutment contacts one or more of the inner abutments 5020, 5022, 5026 , Serve as a functional locking edge. And, in yet another variation of the shield as described above, the first end 5010 and one or more outer abutments 5024, 5028, 5030 serve as functional locking edges. Here, one or more abutments contact simultaneously at a fixed diameter position. Each inner abutment forms a projection from a triangular-like beveled inner surface 5002 and the outer abutment a correspondingly shaped recess or projection into the larger triangular-like beveled outer surface 5004 Formed, which are configured to receive a smaller inner abutment so that one or more of the inner abutment surfaces contact one or more of the outer abutments, or It is simply received within the receiving area without contact with the outer abutment. In one variation, the shape of the inner and outer abutments can further include a friction fit or snap fit arrangement to further enhance the locking ability, wherein the feature provides an increased friction lock, ledge or gate Including the ridge. Inclined protrusions on the inner surface 5002 facilitate the extension of the shield from the reduced configuration to the expanded configuration. For example, when inserting the shield into the incision / orifice, the shield 5000 is first curled into a reduced configuration so that it can fit into the small incision / orifice, and then the shield 5000 is anchored to Made in a large diameter configuration. When the reduced configuration is anchored to a larger diameter configuration, portions of the outer surface 5004 will ramp up and over the sloped protrusions on the inner surface 5002. After the outer surface rides over the inner surface, the inner abutment contacts the outer abutment to create a first stop or lock position. The shield 5000 can then be further anchored, with the outer surface over the projection of the inner surface at the outer abutment position, to another locking position where the inner and outer abutments contact each other, The same applies to the following. Therefore, the expansion of the shield is performed in a ratchet-like manner, and the diameter dimension gradually increases during the locking interaction with one or more abutments. In one variation, shield 5000 does not have an outer abutment formed on the outer surface. Instead, the shield 5000 has a receiving area for receiving the inner abutment, on which the outer surface overlaps to provide a flush position, where the locking feature is such that the inner abutment is first. This may occur when contacting end 5010 or, in one variation, upon contacting one or more outer abutments formed in the receiving area. Thus, the receiving area not configured for abutments formed on the outer surface 5004 can have any shape on the outer surface. The inner surface opposite the receiving area may have a beveled or other curved configuration to facilitate movement of the shield between the reduced configuration and the expanded configuration. This tilting feature advantageously makes the shield 5000 easy to use, as anchoring the shield to a larger diameter does not require a separate step to mechanically unlock the locking arrangement. Instead, the shield is simply curled or otherwise moved circumferentially and, in a ratchet-like manner, rides over the inward projection and enters the locking position of the adjacent abutment.

  The shield 5000 shown in FIGS. 164-167 is adjustable to have four different inner diameter sizes. When inserted inside an incision or body orifice, the shield 5000 provides protection and can follow an incision of approximately 1 inch or less. Of course, a larger shield 5000 can be made to be placed inside a larger incision / orifice such as a vaginal canal. Such shields can also be made to have a length greater than that shown in FIGS. 164-167. The shield 5000 provides for retraction of tissue at the incision / orifice. When inserted into the incision / orifice, the shield 5000 is curled into a reduced configuration to be inserted into the small incision / orifice, and then the shield 5000 is anchored into a larger diameter configuration and the shield Multiple lock positions are available to customize the lock position. Therefore, the shield 5000 plays the role of retracting or enlarging the incision or orifice simultaneously with the enlargement of the shield diameter and working channel. The shield 5000 of FIGS. 164-167 allows the shield to follow the incision up to approximately 1.5 inches in diameter while providing retraction. Retraction of the surrounding tissue increases working space and provides the user with better stability.

  Furthermore, the locking mechanism of the shield 5000 is unique because it relies on the radial pressure externally applied to the shield 5000 and to the outer surface 5004. Thus, the shield 5000, and in particular the locking mechanism of the shield, functions in one variation when the shield is inserted into an incision sized equal to or smaller than the inner diameter of the minimum reduced configuration of the shield. The surrounding tissue exerts a radial force around the circumferential direction of the periphery of the shield 5000, which brings the first end 5010 into abutment with one or more of the inner abutments, or the inner ridges. And / or abut one or more inner abutments with one or more outer abutments. The surrounding tissue edge exerts a compressive force on the shield. The shield is configured to utilize a component of force tangential to the circumference of the shield, moving both the inner and / or outer vertical abutments, and / or the ridge and / or the first end And one or more other abutments or ridges, the first end or other vertical structure to contact and thereby prevent the shield from collapsing, at the same time, to provide the locking feature Ru. The structure of the shield perpendicular to the circumferential surface such as the abutment / end / ridge supports the structure and reinforces it to make the shield stronger. A variation of the shield having a lock position and configuration such that the surfaces of more than one abutment pair contact simultaneously for a given lock position makes the shield stronger and attempts to crush the retracted tissue position. Makes it possible to withstand the forces it tends to do. An abutment inside the tissue opening that forms a contact surface that acts as a locking feature to further enhance the radial strength of the shield while retracting the tissue and under pressure of the tissue surrounding the shield Any one or more of the mentment / ridge / ends are close to the top end 5006 or the top end 5006 to provide strength and substantially uniform reinforcement from top to bottom along the length of the shield Or near the bottom end 5008 or near the bottom end 5008, or at least equal to or greater than 50 percent of the surface length of the shield. The tissue pressure exerted on the shield while the shield is in the incision / orifice forces the leading edge and the outer abutment to enter the corresponding inner abutment, and also the ridges formed in the shield and Due to the steps (their distances being equal to the width of the shield wall), it is possible for the overlapping faces of the shield to be arranged flush within the shield. Because the shield is shaped and biased towards a larger static configuration, the shield configured in the reduced configuration with the surfaces abutted in a reduced and locked configuration when the tissue pressure on the shield is absent. I will not leave. Therefore, the lock is, in one variation, a living lock that requires tissue pressure to effect the lock configuration. The tissue pressure at the incision / orifice position cooperates to hold the abutment surface in a locked configuration. In use, the shield is placed from the static configuration to the reduced configuration by first closing the gap and placing the first end of the band over at least a portion of the second end of the band. The overlap is increased by curling the band down to further reduce the inner diameter to a size that fits within the incision / orifice. The shield is inserted into the incision / orifice and released inside the incision / orifice, and the diameter of the incision / orifice is smaller than the reduced configuration of the shield or the size of the shield anchors from the reduced configuration It receives pressure from surrounding tissue that is caused by the increase. The shield is curled in the reverse direction to increase the inner diameter of the shield. An increase in inner diameter tends to retract tissue at the edge of the incision / orifice. Recession of the tissue increases the bias that the tissue exerts against the shield. By reducing the amount of overlap of the shields, the abutments are in a continuous locking position in a ratcheting manner, where one or more abutments contact each other or the ends or ridges. Contact with the abutment prevents the shield from collapsing and secures the inner diameter. When viewed from the top along the long axis of the shield, the shield forms a spiral in a plane perpendicular to the long axis when in the reduced configuration. When in the stationary configuration, the shield, in one variation, forms an open circle or an open oval. In another variation, the first end of the shield slightly overlaps the second end of the shield. The locking mechanism, in cooperation with the tissue pressure, serves to anchor the shield to the incision / orifice. Because of the lock, an aggressive C-curve on the outer surface is not necessarily required to assist in anchoring the shield in the incision / orifice. If there is no lock, wedge the positive C-shaped outer lower flange into the incision / orifice and let the upper flange rest against the tissue surface to secure the shield to the patient To help. The locking mechanism advantageously allows the working channel and the inner diameter to be maximized without being reduced by the positive C-curve on the side wall of the band. In one variation, the shield does not have a curved profile or only a slightly curved profile to maximize the inner diameter, and relies more on a locking mechanism to anchor the shield to the patient. The outer step of the second end of the band further maximizes the inner diameter at the point where one portion of the band overlaps another portion of the band so that the inner diameter is reduced at the overlapping position instead of being uniform Generate an inner diameter of one. In one variation, the shield does not have an outer abutment, but instead has a receiving area that is sized and configured to receive the inner abutment when the shield is spiraled to overlap the inner abutment. To be The receiving area prevents the overlapping bands from buckling inwardly towards the central lumen. Instead, the inner abutment is received within the receiving area to maximize the inner diameter and produce an even band arrangement around the inner diameter, even at the location of the overlapping portion of the bands. In the most reduced configuration where the shield has the smallest inside diameter, the first end contacts the inner ridge and all the inner abutments are received in the receiving area or contact the corresponding outer abutments.

  Referring now to FIG. 168, another shield 5000 according to the present invention is shown, like numerals being used to indicate like parts. The first end 5010 includes a projection 5034 sized and configured to fit within a slot 5036 formed in the second end 5012. The abutment of the protrusions 5034 against the slots 5036 creates a locking arrangement to prevent further reduction of the inner diameter. As shown in FIG. 168, the slots 5036 are oriented substantially vertically and the slots 5034 are curved to follow the curvature of the band of the shield. Although one slot 5036 is shown, multiple slots 5036 can be provided to provide variability in the lock diameter.

  Referring now to FIGS. 169-170, there are other variations of the lock shield 5000. FIG. The shield 5000 includes a first end 5010 configured to slide into a slot 5036 formed in the second end 5012. A plurality of slots 5036 are provided to provide variability in lock diameter. Each slot 5036 is substantially C-shaped to form a tongue 5038, behind which a first end 5010 is inserted to fix the inside diameter. The shield 5000 is unlocked by increasing the diameter by pulling the interlocked segments of the band apart.

  Referring now to FIG. 171, there is another variation of a shield 5000 having a locking mechanism. The shield 5000 includes one or more longitudinal slots 5036 formed in the second end 5012. A plurality of slots 5036 are provided to give the shield 5000 variability in the locked position. The first end 5010 includes a protrusion 5034 having an outwardly extending hook 5040 sized and configured to be received within any one of the slots 5036. The hooks 5040 abut the slots 5036 openings to inhibit the reduction or expansion of the inner diameter. The lock is released by bending the first end 5010 inward to disengage the hook 5040 from the slot 5036 opening.

  Referring now to Figures 172-174, another variation of a shield 5000 having a locking mechanism is shown. The shield 5000 includes a first end 5010 provided with one or more holes 5042. A plurality of holes 5042 are provided to provide a variable locking position along the band to adjust the inner diameter and lock it in the desired position. The second end 5012 of the shield 5000 includes a protrusion 5034. The protrusion 5034 includes a circular head connected to the neck portion 5044. The protrusions 5034 extend radially inward from the inner surface 5002 of the band. Each hole 5042 has two parts. The first portion of the hole 5042 includes an opening shaped to correspond to the head of the protrusion 5034 and sized to allow the head of the protrusion 5034 to pass through the hole 5042, as shown in FIG. There is. As shown in FIG. 174, the protrusion 5034 is then moved into the second portion of the hole 5034 forming a channel for the neck portion 5044 and a restraint for the head portion so that the protrusion 5034 is a hole When inside the second portion of the 5034, the head portion can not be removed unless the head portion is aligned with and passed through the first portion of the hole 5034. The slot-lock secures the head portion of the protrusion 5034 of the second portion 5012 in one of the holes 5042 along the first end 5010 to secure and lock the inner diameter, the size of which expands or Prevent shrinking.

  Referring now to FIG. 175, another variation of a shield 5000 having a locking mechanism is shown. The lock includes a protrusion 5034 extending outwardly from the outer surface 5004 near the first end 5010. The protrusions 5034 are longitudinally oriented. The second end 5012 includes one or more longitudinally oriented slots 5036 of corresponding shape. A plurality of slots 5036 are provided for variability of the shield 5000 size and inner diameter adjustment. The first end 5010 is bent inwardly and nested within the second end 5012 to spiral the shield 5000 into a smaller inside diameter. When the desired inner diameter for a particular surgical purpose is achieved, the protrusions 5034 are aligned with the desired slots 5036 for the desired inner diameter and the protrusions 5034 are inserted into the slots 5036. The projections 5034 abut the slots 5036 to prevent expansion or contraction of the size and inner diameter of the shield 5000, thereby locking the inner diameter of the shield 5000 in the desired configuration. In order to unlock the shield 5000, the projections 5034 can be slotted 5036 by bending the first end 5010 inwardly or bending the second end 5012 outwardly to release the projections 5034 from the slots 5036. Push back in the reverse direction and remove. In the unlocked configuration, the size of the inner diameter can be reduced so that it can be easily withdrawn from the incision or body orifice. The shield 5000 can be readjusted and relocked to have an increased or decreased inner diameter, as desired, while present in the incision / orifice.

  Referring now to FIG. 176, another variation of a shield 5000 having a locking mechanism is shown. The lock includes one or more protrusions 5034 extending outwardly from the inner surface 5002 near one of the first end 5010 and the second end 5012. The protrusions 5034 are oriented laterally, perpendicular to the inner surface 5002 and / or the longitudinal axis. In FIG. 176, one protrusion 5034 is located near the top end 5006 and another protrusion (not shown) is located near the bottom end 5008. The second end 5012 includes one or more laterally oriented slots 5036 of one or more corresponding shapes, which are sized and configured to receive one or more protrusions 5034. ing. A plurality of slots 5036 are provided along the circumference of the shield 5000 to provide variability in the adjustment of the size and inner diameter of the shield 5000 and the locking position. The first end 5010 is bent inwardly and nested within the second end 5012 to spiral the shield 5000 into a smaller inside diameter. When achieving a specific surgical purpose, size of the incision, orifice or desired inner diameter for the tissue to be excised, one or more projections 5034 may be one or two corresponding for the desired inner diameter Align to one or more slots 5036. Each protrusion 5034 is inserted into the corresponding slot 5036. The projections 5034 abut the slots 5036 to prevent expansion or contraction of the size and inner diameter of the shield 5000, thereby locking the inner diameter of the shield 5000 in the desired configuration. The top end 5006 and the bottom end 5008 are uniformly locked relative to one another. In order to unlock the shield 5000, the projections 5034 can be slotted 5036 by bending the first end 5010 inwardly or bending the second end 5012 outwardly to release the projections 5034 from the slots 5036. Push back on and off to achieve the unlocked configuration. In the unlocked configuration, the size of the inner diameter can be reduced so that it can be easily withdrawn from the incision or body orifice. The shield 5000 can be readjusted and relocked to have an increased or decreased inner diameter, as desired, while present in the incision / orifice.

  Referring now to FIG. 177, another variation of shield 5000 having a locking mechanism is shown. The lock includes at least one abutment 5020 extending outwardly from and perpendicular to the inner surface 5002 near the second end 5012. The abutment 5020 extends longitudinally oriented between the top end 5006 and the bottom end 5008. A plurality of abutments 5020 are provided, each spaced from the second end 5012 to provide variability in the adjustment of the size and inner diameter of the shield 5000. The plurality of abutments 5020 form a step-like arrangement of curved steps along the inner surface 5002, and the first end 5010 is configured to abut against it. The first end 5010 is a curved edge that corresponds to the curvature of the shield 5000. An abutment of any size and shape can be provided at one location, as well as at the other end of the shield 5000, or at another location along the inner or outer surface of the shield, such as at the first end 5010. A corresponding shape of abutment can be provided. The first end 5010 is bent inwardly to nest inside the second end 5012. Spiral the shield to a smaller inside diameter. Other abutments at or near the first end 5010 or the first end 5010 may be provided with the second end 5012 of the shield 5000 when achieving the desired inner diameter for a particular surgical purpose. Aligned with one of the abutments 5020 near or on the other side and placed in contact therewith. The contact between the first end 5010 and the abutment 5020 causes a lateral / diametrical lock which prevents the reduction of the size of the shield and its inner diameter. This locking arrangement, however, allows for expansion of the lateral / diametrical dimension. If expansion occurs, the first end 5010 can move into contact with the adjacent abutment 5020 and snap-fit thereon to create another locking position. In order to release the lock, the first end 5010 is moved out of contact with the abutment 5020 to allow for variability in shield size. In the unlocked configuration, the size of the inner diameter can be reduced so that it can be easily withdrawn from the incision or body orifice. The shield 5000 can be readjusted and relocked to have an increased or decreased inner diameter, as desired.

  Referring now to FIG. 178, another variation of shield 5000 having a locking mechanism is shown. The lock includes at least one abutment 5020 extending outwardly from and perpendicular to the inner surface 5002 near the second end 5012. The abutment 5020 extends longitudinally oriented between the top end 5006 and the bottom end 5008. A plurality of abutments 5020 are provided, each spaced from the second end 5012 to provide variability in the adjustment of the size and inner diameter of the shield 5000. The plurality of abutments 5020 form a step-like arrangement of curved steps along the inner surface 5002, and the first end 5010 is configured to abut against it. The first end 5010 is a curved edge that corresponds to the curvature of the shield 5000. An abutment of any size and shape can be provided at one location, as well as at the other end of the shield 5000, or at another location along the inner or outer surface of the shield, such as at the first end 5010. An abutment of corresponding shape can be provided. Shield 5000 further includes one or more protrusions 5034 extending outwardly from inner surface 5002 and adjacent to at least one abutment 5020. One protrusion 5034 is provided adjacent to each abutment 5020. In the variation shown in FIG. 178, three abutments 5020 are shown and three projections 5034 are shown adjacent to each abutment 5020. The protrusions 5034 are cylindrical in shape but can be of any shape. The abutment 5020 and the projection 5034 are associated with the second end 5012 of the band. The band includes one or more holes 5042 formed at or near the first end 5010. The holes 5042 are sized and configured to receive the protrusions 5034 and are spaced apart such that when in one diameter arrangement of the shield 5000, all of the protrusions 5034 can be inserted into the corresponding holes 5042. The first end 5010 is bent inwardly to nest inside the second end 5012. Spiral the shield to a smaller inside diameter. Other abutments at or near the first end 5010 or the first end 5010 may be provided with the second end 5012 of the shield 5000 when achieving the desired inner diameter for a particular surgical purpose. Are aligned with and in contact with one of the abutments 5020 near or on the other side. The corresponding one or more projections 5034 then penetrate the corresponding holes 5042 to lock the shield in place. The contact between the first end 5010 and the abutment 5020 causes a lateral / diametrical lock which prevents the reduction of the size of the shield and its inner diameter. The abutment of the projections 5034 against the holes 5042 creates a lateral / diametrical lock which prevents the increase and the contraction of the size of the shield and its inner diameter. In order to release the lock, one or more protrusions 5034 of the second end 5012 are moved out of the one or more holes 5042 of the first end 5042 and the first end Move 5010 out of contact with abutment 5020 to allow for variability in shield size. In the unlocked configuration, the size of the inner diameter can be reduced so that it can be easily withdrawn from the incision or body orifice. Of course, shield 5000 can be readjusted and relocked to have an increased or decreased inner diameter, as desired.

  Referring now to FIGS. 179-180, another variation of shield 5000 having a locking mechanism is shown. The shield 5000 includes a plurality of crimps 5046 around the band or near at least the first end 5010 and near the second end 5012. The variation of FIGS. 179-180 includes a fold all around the circumference of the shield 5000. The fold 5046 is a longitudinally oriented fold extending along the major axis. The folds alternately form a plurality of peaks 5048 and valleys 5050 around the circumference of the shield 5000. Peaks 5048 project inwardly into the central lumen towards the long axis, and valleys 5050 are located between peaks 5048. The valleys 5050 project outwardly in a direction away from the longitudinal axis and away from the central lumen. Peaks 5048 and valleys 5050 are correspondingly shaped such that each peak 5048 is received or nested within each valley 5050 in an interlocking manner. Peak 5048 is formed by band bending. The fold 5046 is a longitudinal fold or bellows extending along the major axis. The folds 5046 facilitate reducing the diametrical / lateral dimensions of the shield 5000 by providing multiple hinge locations around the circumference. Peaks 5048 at inner surface 5002 form valleys 5050 at outer surface 5004. The first end 5010 or the second end 5012 is bent inward and nested inside the other of the first end 5010 or the second end 5012. Spiral or curl the shield 5000 to a smaller inside diameter. When achieving the desired inner diameter, one or more peaks 5048 may be nested within one or more valleys 5050 to form a locking configuration, as shown in FIG. The reduction and expansion of the lateral / diametrical dimension is fixed. Nesting one or more peaks 5048 of the inner surface 5002 of the second end 5012 into one or more valleys 5050 of the outer surface 5004 of the first end 5010, tangential, circular Contact in the circumferential direction. In order to release the lock, one or more peaks 5048 are removed from abutment in one or more valleys 5050. In the unlocked configuration, the size of the inner diameter can be reduced so that it can be easily withdrawn from the incision or body orifice. Of course, shield 5000 can be readjusted and relocked to have an increased or decreased inner diameter, as desired.

  Referring now to FIG. 181, another variation of shield 6000 is shown. The shield 6000 is made of a rigid material such as plastic or metal or other material. The shield 6000 includes a first end 6002 interconnected with the second end 6004 between the outer circumference 6006 and the inner circumference 6008. Between the outer circumference 6006 and the inner circumference 6008, the shield 6000 defines a curve that extends between the first end 6002 and the second end 6004. Although the inflection curve in FIG. 181 is curved, the present invention is not limited thereto. Shield 6000 includes a flange 6010 having an upper surface 6012 that defines a thickness therebetween and an opposite lower surface 6014. The flanges 6010 are substantially planar and provide a cutting board-like surface for performing manual molaration and protecting adjacent tissue. Flange 6010 interconnects with depending portion 6016. The depending portion 6016 includes an inner surface 6018 continuous with the upper surface 6012 of the flange 6010. The depending portion 6016 includes an outer surface 6020 continuous with the lower surface 6014 of the flange 6010. The depending portion 6016 is curved. In one variation, the arc defined between the first end 6002 and the second end 6004 is less than or equal to approximately 180 degrees. In another variation, the arc defined between the first end 6002 and the second end 6004 is between approximately 45 degrees and 290 degrees. The shield 6000 is configured to allow the depending portion 6016 to be inserted into an incision or orifice or other body opening to partially retract the tissue edge circumferentially at the incision. The depending portion 6016 acts as a hook to secure the flange 6006 at the incision site and to provide protection of the surrounding tissue. The shield 6000 is rigid and cut resistant, allowing the surgeon to safely molarate against the flange 6012. The shield 6000 of FIG. 181 can be used as such, inserted directly into the incision / orifice, or used in combination with the retractor and / or storage bag described herein. A 2-ring retractor with webbing in between is inserted into the incision site or orifice, and the upper ring is rolled to retract the tissue edge by rolling the webbing around the upper ring as described herein . After retracting the incision / orifice, shield 6000 is placed inside the retractor to protect the surrounding tissue and webbing of the retractor from inadvertent incision during the morsulation procedure. The flange 6010 is large enough to overlap surrounding tissue such as the abdominal wall and provides a protective shelf / apron to the patient. The depending portion 6016 is shown curved, but the invention is not so limited and the depending portion may be flat or C-shaped. The C-shaped depending portion can assist in hooking the shield 6000 to the incision site. All of the methods described in the present application for guards and / or shields are compatible, with or without storage bags and / or retractors and / or other devices described herein or known to those skilled in the art It is applicable to all of the guards and shields described herein, including but not limited to their use.

  Referring now to FIGS. 182-189, another variation of shield 7000 adapted for placement in the vaginal canal is shown. Although the shield 7000 is adapted for placement in the vagina, it can also be adapted for placement in other orifices and / or incisions by applying variations in size and shape. Shield 7000 includes a guard portion 7002 connected to batten 7004.

  With further reference to FIGS. 182-189, guard portion 7002 is substantially tubular in shape having an outer surface 7006 and an inner surface 7008 defining a lumen 7010. The lumen 7010 can be of any shape, such as circular or oval. In one variation, the lumen 7010 transitions from an oval at the proximal end opening to a circular at the middle and an oval at the distal end opening. The inner surface 7008 follows the outer surface 7006 to define a thickness therebetween. The guard portion 7002 is made of a cut resistant flexible polymer. In another variation, the guard portion 7002 is rigid. The distal end of the tip includes a bead 7012 formed with the guard portion 7002. The bead 7012 is located at the outer periphery of the distal end opening. The bead 7012 has a curved surface and has an increased thickness relative to the sides of the guard portion 7002. The beads 7012 increase in size at the distal end to form hook-like features or protruding discontinuities on the outer surface 7006. In one variation, the beads 7012 are formed only against the outer surface 7006, the inner surface 7008 is smooth and there are no discontinuities at the bead location. Guard portion 7002 also includes a proximal end opening. Guard portion 7002 defines a length of shield 7000 between the proximal end opening and the distal end opening. The length of the shield 7000 is such that when the shield 7000 is placed inside the vagina, the bead 7012 advantageously extends just past the pubis so that the bead 7012 engages with the patient's pubic bone and dissects the shield 7000 It is configured to be fixed relative to the anatomical structure to prevent it from being withdrawn proximally from the vagina. Thus, the bead 7012 is larger or more raised at the distal end along the top of the guard portion 7002 that will engage the pubic bone, as compared to the bottom of the guard portion 7002. In one variation, the beads 7012 can be uniform in size and shape all around the distal end opening. The shield 7000 does not necessarily have to be anchored to the pubic bone and may contact the vaginal muscle wall. In one variation, the proximal end opening does not include a bead, and in another variation, the proximal end bead is provided to provide the proximal end with an anatomical structure or other device such as a retractor, a storage bag, or Assist in mooring to any of the other access devices such as gel cups.

  Referring now to FIG. 188, the shape of the guard portion 7002 will now be described in more detail. Guard portion 7002 is substantially hourglass-like in shape. In one variation, the hourglass shape includes an angled proximal opening and an angled distal opening, as shown in FIG. Specifically, the distal end opening is at an angle 7016 relative to the horizontal plane, and the proximal end opening is at an angle 7018 relative to the horizontal plane. The horizontal plane is substantially perpendicular to the major axis 7020. The transverse axis (not shown) extending through the page is parallel to the plane containing the proximal and distal openings. In one variation, the angles 7016, 7018 are substantially equal, making the planes containing the proximal and distal openings substantially parallel to one another. In one variation, only the distal end is angled, which means that the plane containing the distal opening forms an angle 7016 less than 90 degrees with the horizontal plane at an angle with the horizontal plane The upper end is inclined forward so that it leads in the insertion orientation of the shield. The angled proximal and distal end openings advantageously facilitate the insertion of the shield 7000 into the vaginal orifice, producing a lower insertion profile, which is described in more detail with respect to FIGS. 189A and 189B. Be done. With further reference to FIG. 188, the side sections of the guard portion 7002 are curved with respect to the longitudinal axis 7020 such that the outer surface 7006 of the side section is concave and the inner surface 7008 is convex to follow. As can be seen from FIG. 188, the side sections are substantially hyperboloid shaped, but the curvature with respect to the major axis 7020 in the illustrated cross section need not be hyperbolic. The cross section of the guard portion 7002 can be described generally as C-shaped, which is rotated about the longitudinal axis 7020 to create the lumen 7010 and tubular shape. FIG. 188 also shows the increased bead 7012 thickness relative to the side sections, as well as the reduced bead 7012 thickness at the top of the guard portion 7002 relative to the bottom. Also, the bottom of the guard portion 7002 at the proximal end opening has a larger flange 7022, which advantageously covers and protects the female anatomy around the vaginal opening. The shield 7000 generally, and the guard portion 7002 in particular, acts as a protective surface to guard vaginal bag tissue in the storage bag, retractor, and insertion positions. The shield 7000 is made of a rigid, rigid or semi-rigid, flexible, compliant, plastic or cut resistant material, or any material suitable to one skilled in the art. Shield 7000 is a protective surface that guards the surrounding tissue and storage bag and / or retractor from sharp objects such as surgical scalpels, blades or morserators used to cut or shrink target tissue for excision I will provide a. Shield 7000 also provides an amount of retraction that maintains an effective working channel that remains open without collapsing.

  The top of the guard portion 7002 includes a channel 7024 sized and configured to receive the batten 7004. Channel 7024 can be clearly seen in FIG. Channel 7024 includes a channel opening at the proximal end of guard portion 7002 for receiving batten 7004 and a closed distal end protected by the increased thickness of bead 7012. Channel 7024 is shaped so that batten 7004 can be inserted into and removed from channel 7024. For example, batten 7004 can be inserted into channel 7024 for insertion of shield 7000 and can then be removed when the shield is placed in the anatomical structure. In another variation, the guard portion 7002 is not removable as it is molded over the batten 7004. In another variation, the batten 7004 is not removable because the batten 7004 can be secured with an adhesive or other means. The guard portion 7002 around the channel 7024 is thicker than the side sections, providing reinforcement to the guard and protection of the anatomical structure from the relatively rigid batten 7004.

  Batten 7004 will now be described in more detail with reference to FIG. 187A. Batten 7004 is substantially L-shaped and has a curved lower leg 7026 that follows the curvature of channel 7024 and the curved side sections of guard portion 7002. Upper leg 7028 is substantially straight and sized and configured to be easily grasped by the surgeon's hand for insertion purposes. The batten 7004 is made of a relatively stiffer material than the guard portion 7002 and provides the guard portion 7002 with rigidity and reinforcing properties that facilitate the handling and insertion of the shield 7000 and the fixation of the shield 7000 to the anatomical structure. It is supposed to be. Therefore, the batten 7004 can be made of a rigid polymer, plastic or metal. The side sections of the guard portion 7002 have a softer durometer hardness than the batten 7004, such that the batten 7004 stiffens and reinforces the webbings of the side sections to facilitate the insertion of the shield 7000. The lower and upper legs 7026, 7028 of batten 7004 have a width of approximately one inch. The lower leg 7026 is curved and has a concave outer surface along its length and a convex outer surface along its width. Lower leg 7026 is also curved and has a convex surface along its length and a concave inner surface along its width to follow the shape of inner surface 7008 and outer surface 7006 of guard portion 7002 ing. The batten 7004 may be located anywhere along the perimeter of the guard portion 7002. For example, the batten 7004 can be disposed at the bottom of the guard portion 7002 with or without the channel 7024 as shown in FIG. 187B, and the upper leg 7028 of the batten 7004 that serves as the handle portion can be Angle down towards the back of the patient when serrations may require back protection. In another variation, batten 7004 is completely omitted from the structure, as shown in FIG. 187C.

  Referring now to FIGS. 189A-189B, the insertion of shield 7000 into the vagina or other orifice / incision will now be described. The batten 7004 is inserted into the channel 7024 sized and configured to receive the lower leg with a friction fit or other type of engagement. When the batten 7004 is held in the channel 7024, the shield 7000 is gripped by its upper leg 7028 and angled with respect to the orifice to round the distal and distal ends of the lower leg 7026 of the batten 7004. A beaded bead 7012 guides the insertion and acts as a tip 7030. Movement of the shield 7000 is pendulous around the proximal end of the upper leg, resulting in an arcuate insertion path. The shape of the guard portion 7002 resulting from the angled distal end opening creates a wedge-like proximally increasing tip 7030 to form an acute angle shown by the V-shaped dashed line 7032 in FIG. 189A. This wedge-like arrangement advantageously serves to retract the tissue to facilitate insertion. At the tip 7030, the user advances the shield 7000 while retracting the tissue orifice along the track, and then rotates the shield 7000 upward to place the tip 7030 under the pubic bone or other tissue in the upper portion of the bead 7012 The shield 7000 can be anchored to the anatomical structure by hooking. The user manipulates shield 7000 to rotate shield 7000 upward / forward and into position, as can be seen in the progression from FIG. 189A to FIG. 189B.

  Referring now to FIGS. 190A-190C, a shield 7000 having a guard portion 7002 made of a flexible material, with or without the batten 7004, may be inserted into the guard portion 7002 from the undeformed state shown in FIG. 190A. It is manipulated for insertion by folding into the cavity 7010 into a deformed state with a reduced size at the distal end as shown in FIG. 190B. The bottom end of shield 7000 is bent upward in the direction indicated by the arrow in FIG. 190A. A finger inserted inside the lumen 7010 of the shield 7000 can easily grip the guard portion 7002 and squeeze the guard portion 7002 into a deformed configuration or fold the guard, as shown in FIG. 190C. It can be U-shaped with a reduced distal end suitable for insertion. Once in place, the finger can release the guard portion 7002, and since the guard portion 7002 is a flexible material, the guard portion 7002 is spring biased towards its undeformed state, It is advantageously anchored inside the vagina. In another variation, shown in FIG. 190D, an introducer 7036 is used to facilitate the insertion of shield 7000 into the orifice.

  The shield 7000 can also be used in combination with the retractor 724. The retractor 724 is the same retractor 62 as described with respect to FIGS. 18-19. Retractor 724 includes a first ring 726 and a second ring 728 interconnected by flexible side wall 730. Side wall 730 defines a central opening extending along the longitudinal axis of retractor 724. The second ring 728 can be compressed and inserted through the vaginal canal where it expands and contacts the vaginal interior to form a fixation. The first ring 726 is external to the patient and above the vaginal entry where it can be rolled down to retract and enlarge the vaginal canal. The shield 7000 is inserted into the central opening of the retractor 724 following placement of the retractor 724. The bead 7012 at the distal end of the shield 7000 is configured to be connected to the second ring 728 of the retractor, and the proximal end such as the flange 7022 of the guard portion 7002 is connected to the first ring 726 Configured to secure the shield 7000 to the retractor 724. The proximal and distal ends of the shield 7000 can be snapped under or over the first and second rings 726, 728, respectively. Alternatively, the retractor 724 can be provided with a channel 7024 and a batten 7004 inserted into the channel 7024 to aid in the placement and stiffening of the retractor 724. The batten 7004 may be removed to roll down the first ring 726 of the retractor 724, which may or may not then be reinserted into the channel 7024.

  In hysterectomy, uterine myomectomy or other procedures, the uterus is peeled from the body through the vagina or by an instrument inserted through one or more abdominal ports. After abrading the uterus, shield 7000 can be inserted directly into the vagina as described above using Batten 7004, manipulating tip 7030 to guide insertion and bead 7012, eg, under pubic bone or vagina Adhere to and moor. The proximal flange 7022 is near the vaginal entry. The exfoliated uterus can be grasped and drawn into the lumen 7010 of the shield 7000, and the blade can safely molarate the uterus, cutting the uterus into smaller pieces and removing it completely through the vagina Make it possible to

  In another variation, the storage bag can be placed inside the abdominal cavity either through the abdominal port or through the vaginal canal. The removed uterus is placed in the storage bag. The bag includes a tether and a proximal flexible ring. Pull the storage bag tie through the vagina. The proximal ring of the storage bag is compressed into a low profile configuration to facilitate pulling the proximal end of the storage bag through the vagina. The ring of the storage bag is pulled out of the body and expanded to the open configuration, thereby opening the storage bag's mouth. The ring on the storage bag is outside the vaginal entry. The storage bag ring can be rolled down to roll the side walls of the bag over the storage bag ring. This action brings the removed uterus inside the bag closer to the vaginal opening. The shield 7000 is then inserted into the mouth of the storage bag and into the vaginal canal. The proximal flange 7022 is at or near the vaginal entrance. In one variation, the proximal flange 7022 of the shield 7000 is snapped onto or under the ring of the storage bag. In such embodiments, the proximal flange 7022 can include bead-like reinforcements for snap-fitting to a bag or other device such as a gel cap. The removed uterus can be grasped with a grasper and drawn into the lumen 7010 of the shield 7000, where morseration can be initiated.

  The distal end of the shield 7000 is angled as described above, which advantageously assists in moving the abraded uterus into the shield 7000. The uterus is morseled with a blade while at least partially present in the shield 7000 before being completely removed in whole or in part. The shield 7000 advantageously protects the surrounding tissue as well as the storage bag from sharp blades and helps to maintain the integrity of the storage bag and closed molsulation system while expanding the working channel space And increase.

  In another variation, the same procedure is followed as in the previous paragraph, but the retractor 724 is inserted into the mouth of the storage bag after placing the uterus in the storage bag and pulling the ring of the storage bag out of the body. The second ring 728 of the retractor 724 is compressed for easy insertion into the mouth of the storage bag and then expanded inside the storage bag to an open configuration at a location distal to the vaginal canal inside the abdominal cavity. The first ring 726 of the retractor 724, which is external to the body, is rolled about itself to roll the sidewall 720 of the retractor 724 onto the first ring 726. This action not only retracts the vaginal canal, but also retracts the storage bag from the path, freeing the vaginal canal for insertion of the shield 7000. A storage bag is captured between the retractor and the vaginal canal to keep it in place and prevent it from moving into or out of the vaginal canal. The shield 7000 is then inserted into the central lumen of the retractor 724 inside the storage bag. The shield 7000 can be retracted or retracted by snapping one or more of the proximal and distal ends to the first ring 726 or the second ring 728 of the retractor 724 or to the ring of the storage bag. It can be attached to the bag. The uterus can then be grasped with a surgical instrument and pulled into the central lumen 7010 of the shield 7000 from the unprotected pouch of the storage bag, where the uterus is completely or completely removed before removal. While being at least partially within the shield 7000. The shield 7000 advantageously protects the surrounding vaginal canal as well as the storage bag and retractor from sharp blades and helps the surgeon maintain the integrity of the storage bag and the closed molaration system while Provide a mechanism to perform serration safely and quickly.

  In another variation, the same procedure is performed as in the previous paragraph except that the retractor 724 is placed in the vaginal canal before the storage bag with the sample therein is pulled through the vaginal canal. In this variation, the removed uterus is placed inside the storage bag located inside the body cavity, and a tie strap attached to the proximal end of the storage bag is pulled by the grasper through the central lumen of the retractor to ring the storage bag And bring the mouth out of the patient. The ring on the storage bag can then be rolled down to bring the peeled uterus close to the opening. Thereafter, the shield 7000 is inserted. This retracts the storage bag and creates a working channel through the central lumen 7010 of the shield 7000 for movement and molaration of the abraded uterus. The proximal flange 7022 of the shield 7000 can be snapped under the first ring 726 of the storage bag ring or retractor 724. The storage bag is captured between the retractor 724 and the shield 7000, which keeps it from sliding proximally or distally during the procedure. The flange 7022 of the shield 7000 can also serve as a cutting board surface, protecting against sharp blades used to cut the uterus for removal. For all of the above procedures, the storage bag and retractor combination of FIG. 20 can be used in place of one or more of the storage bag and retractor 724 combinations.

  It will be understood that various modifications may be made to the embodiments disclosed herein. Accordingly, the above description should not be construed as limiting, but merely as exemplary of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure.

Claims (36)

A surgical shield for insertion into a patient's orifice and its protection,
A guard portion formed of a cut resistant material, having a generally tubular shape having an inner surface and an outer surface defining a thickness therebetween, and a proximal opening at a proximal end and a distal opening at a distal end A guard portion defining a lumen extending along the longitudinal axis therebetween;
A batten having a reinforced portion connected to a handle portion, the reinforced portion being connected to the guard portion and extending along the longitudinal axis of the guard portion, the handle portion being closer to the guard portion A batten located at the proximal end and extending away from the proximal end of the guard portion;
A surgical shield, comprising: A surgical shield for insertion into a patient's orifice and its protection,
A guard portion made of a cut resistant material, having a generally tubular shape defining a lumen extending along the longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end A guard portion having a transverse axis perpendicular to the longitudinal axis,
The surgical feature characterized in that the distal opening is in a distal plane at an angle to the longitudinal axis to facilitate insertion of the distal end of the shield into an orifice of the patient. shield. Providing a shield having a guard portion having an expanded and contracted state, wherein the guard portion is made of a flexible material biased to return to the expanded state, the guard portion comprising: A generally tubular shape defining a lumen extending along the longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end;
Placing the guard portion in a reduced state;
Inserting the shield into the orifice while in the contracted state;
Releasing the shield from the contracted state such that it expands towards the expanded state to abut the orifice;
Method, characterized in that it comprises. Providing a shield having a guard portion made of a flexible material, said guard portion having a longitudinal axis between the proximal opening at the proximal end and the distal opening at the distal end A generally tubular shape defining a lumen extending therealong, the shield further including a batten removably connected to the guard portion, the batten being relatively stiffer than the guard portion, and a handle portion The reinforcement portion extends along the longitudinal axis of the guard portion, the handle portion is located at the proximal end of the guard portion and the proximal portion of the guard portion A step that extends away from the end of the
Connecting the batten to the guard portion;
Inserting the shield into the patient's orifice while the batten is connected to the guard portion;
Method, characterized in that it comprises.   The guard portion includes at least one channel defined between the outer surface and the inner surface, the channel having an opening at the proximal end, the reinforcing portion of the batten being of the channel A surgical shield according to any of the preceding claims, characterized in that it is located inside.   A surgical shield according to any one of the preceding claims, characterized in that the handle portion is at an angle to the reinforcing portion.   A surgical shield according to any of the preceding claims, wherein the batten is removable from the channel.   A surgical shield according to any of the preceding claims, characterized in that the handle portion extends away from the longitudinal axis.   A surgical shield according to any of the preceding claims, wherein the batten is L-shaped.   A surgical shield according to any of the preceding claims, wherein the batten is located on top of the guard portion, the top of the guard portion facing the front of the patient.   A surgical shield according to any of the preceding claims, characterized in that the batten is located at the bottom of the guard part, the bottom of the guard facing the patient's back.   A surgical shield according to any of the preceding claims, wherein the guard portion is made of a flexible material.   A surgical shield according to any of the preceding claims, wherein the batten is relatively stiffer than the guard portion.   A surgical shield according to any of the preceding claims, wherein the guard portion comprises a bead having an enlarged thickness around the distal opening.   A surgical shield according to any of the preceding claims, wherein the guard portion comprises a flange portion depending at the proximal end.   The guard portion has an expanded state and a contracted state, and the guard portion is made of a cut resistant flexible material biased to return to the expanded state. A surgical shield according to any one of the claims.   A surgical shield according to any of the preceding claims, characterized in that the distal plane is parallel to the transverse axis.   A tip according to any one of the preceding claims, characterized in that the distal insertion angle of the tip is defined by the projection of the distal plane and the guard portion relative to a plane perpendicular to the transverse axis Surgical shield.   A surgery according to any of the preceding claims, characterized in that the proximal opening is in a proximal plane at an angle to the longitudinal axis and forms a flange at the proximal end. Shield.   A surgical shield according to any of the preceding claims, characterized in that the proximal plane is parallel to the transverse axis.   A surgical shield according to any of the preceding claims, wherein the distal and proximal planes are substantially parallel.   The lumen has an elongated cross section as viewed in a plane perpendicular to the longitudinal axis at the proximal end, and an elongated cross section as viewed in a plane perpendicular to the longitudinal axis at the distal end. A surgical shield according to any of the preceding claims, characterized in that it comprises.   A surgical shield according to any of the preceding claims, wherein the lumen has a circular cross-section between the distal end and the proximal end.   A surgical shield according to any of the preceding claims, further comprising a batten connected to the guard portion, wherein the batten is more rigid than the guard portion.   The batten has a reinforced portion connected to the handle portion, the reinforced portion is connected to the guard portion, the handle portion is located at the proximal end, and from the proximal end of the guard portion A surgical shield according to any one of the preceding claims, characterized in that it extends away.   A surgical shield according to any of the preceding claims, further comprising a bead around the distal opening.   A surgical shield according to any one of the preceding claims, further comprising a bead around the proximal opening.   The orifice is a vagina and the guard is sized and configured such that when inserted the bead is below the pubic bone and the proximal opening is external to the vagina A surgical shield according to any one of the preceding claims, characterized in that.   A surgical shield according to any of the preceding claims, wherein the guard portion is substantially hourglass shaped.   The shield further includes a batten having a reinforced portion connected to a handle portion, the reinforced portion being connected to the guard portion and extending along the long axis of the guard portion, the handle portion being A method according to any one of the preceding claims, characterized in that it is located at the proximal end of the guard part and extends away from the longitudinal axis.   The guard portion includes an outer surface and an inner surface defining a thickness therebetween, the guard portion further including a channel defined between the outer surface and the inner surface, the channel receiving the reinforcing portion A method according to any one of the preceding claims, characterized in that the proximal end has an opening sized and configured, the reinforcing part of the batten being located inside the channel. .   A method according to any one of the preceding claims, further comprising the step of inserting a batten into the channel of the guard portion prior to the step of inserting the shield into an orifice.   A method according to any one of the preceding claims, wherein the step of inserting the shield into an orifice comprises gripping the handle portion of the batten.   The method according to any of the preceding claims, further comprising the step of removing the batten from the channel after inserting the shield into the orifice and while the shield is located inside the orifice. Or the method described in one item.   The said guard part has an expanded state and a contracted state, The guard part is made of a flexible material biased to return to the expanded state. The method according to any one of the preceding claims.   A method according to any of the preceding claims, comprising removing the batten while the shield is located in the orifice.

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